Journal of Healthcare Management - March/April 2014 - (Page 91)

i MpleMenting H ealtHcare r efor M provider pool and the out-of-pocket expense to see specialists. Thus, specialty access will influence patients' selection of plans and facilities as well as dictate their level of satisfaction. Organizations that have strong specialties will attract, and thus have a greater choice of, patients and payers. 5. Health insurance exchanges. With the new insurance offerings, specialty providers will need to choose which new health plans to participate in, if any. Expect that the lower reimbursement from these plans will decrease physician participation. According to the Medical Group Management Association (MGMA), 40 percent of physician practices are evaluating whether or not they will participate in health exchanges (Torrieri, 2013). Many physicians are taking a cautious approach to these new exchanges. Think of the consequences if a hospital and its specialists do not participate in the same insurance exchanges. Loyal patients could be forced to use a competitor's facility for their total hip replacement. 6. Service lines. The top challenge for hospitals when developing a service line was found to be aligning specialists (Advisory Board Company, 2013). Hospitals will have to consider what service lines they will offer. This decision will primarily depend on the number of qualified specialists in the market who are willing to participate with each hospital. 7. Clinical equity. Specialty groups that consistently provide cost-effective and high-quality care will have significant "clinical equity" and leverage in the valuebased purchasing world. Payers, hospitals, and employers will be looking for narrow market offerings from these top-performing providers. 8. "Healthcare is local" factor. With a greater emphasis on population and community health management, engagement and participation of community specialists will become paramount. Consider the challenges that federally qualified health centers have had finding specialists to accept their referrals. Now, managing the health and welfare of the community population is a requirement and not an option. Overall, patients consistently wish to obtain their specialty care locally and will identify health plans that provide those physicians. 9. Specialty choices determining hospitals' strategies. Hospitals' strategic decisions to develop affiliations with other tertiary or quaternary institutions (e.g., clinics, health systems, academic medical centers) will depend on the availability and loyalty of specialists in their market. Community specialists may have the opportunity to match the quality of care offered by academic medical centers at a lower price point. This factor, coupled with patients' preference to receive care locally, will provide community hospitals with a distinct advantage. 10. Hybrid model of physician integration. Regardless of the fact that more specialists are being employed by hospitals and health systems, the strategy of employing physicians will be less attractive, if not financially unsustainable, for hospitals. Employed and independent medical staffs working together will become more of a reality, and hospitals will look to develop relationships with independent clinicians. New independent physician affiliations, joint ventures, or collaborations will take 91

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014