The start of big changes with healthcare costs

Recently, the Agency for Healthcare Research and Quality released survey results that found that just one percent of Americans accounted for 22 percent of healthcare costs in 2009. While that is a troubling statistic there was some good news: that number has dropped by six percentage points since 1996. As the study’s lead author put it: “That’s a big change.” And it’s a good change, too.

Both of these statistics are eye-openers. But the most important number in the study might have been “2009” – the year the study ended, and the year before healthcare reform became law. If market pressures, population changes and other market dynamics can produce a “big change” like this in the decade preceding reform, just imagine how different this study may look in 2022. 

Data like this has always been of great value to the healthcare industry, which can use it to help predict which segments of the population are likely to produce higher costs. That kind of information can be critical to payers, providers and employers as they plan for their futures, assess their risks and assemble their business plans. But it has never been more important than it is now.

As healthcare reform progresses, the picture is going to get much more complicated. Yes, the influx of newly covered patients into the healthcare system is going to have a dramatic impact on demand, but the challenges are far more complicated and nuanced than 31 million newly insured patients.

Reform-driven changes will also increase demand for free preventative services. Changes to Medicare and Medicaid reimbursement rates, together with an influx of people into the Medicaid system, will have a dramatic impact on some hospitals’ finances – particularly those that serve the top one percent of spenders, who were more likely to be on a public plan.

Forward-looking organizations have always had a serious competitive advantage over those who are hesitant – or ill-equipped – to plan. That advantage will grow as reform and market forces effectively reshape the system and the patient population that uses it; in fact, it may determine the winners and losers by the time the next report of this kind is released. In the meantime, utilizing health intelligence like this as part of an ongoing business strategy is what will set the “planners” apart from the “adapters.”

Jim Bohnsack is vice president of TransUnion Healthcare.

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