In this rapidly changing healthcare landscape health care executives will be held to greater levels of accountability.
Old line managers used to doing business as usual, will have to quickly adapt to the reality of new accountability standards designed by insurance companies.
As the realization dawns that insurance-based reimbursement is becoming the primary source of funding for addiction treatment providers, new rules will govern how Medicaid, private insurance and the healthcare exchanges pay providers. Two of the skill sets provider’s will need in adapting to these new insurance accountability standards includes the need for electronic health record systems and the ability to bill payers electronically.
Real time performance data and the ability of providers to respond effectively to performance-based contracting has enormous implications for the current data systems at both the state and provider levels. Evidence-based practices in service delivery will be demanded.
Providers will operate in an aggressive managed care environment where clinical staff will need to be trained to manage insurance-based reimbursement and managed care entities. National accreditation will become an expectation for all providers.
In the medical integration that is anticipated for addiction treatment services providers, they will need to have contractual linkages with primary care clinics and with federally qualified healthcare facilities. A chronic care model of service delivery has been the long standing norm. However, new expectations on the part of payers will give rise to the need for recovery oriented systems of care in which case managers and others assist patients in accessing needed and often repeated care. Changes within coordinated service continuum will continue to happen with shorter lengths of stay being predicted for most residential programs. Step down care and extended aftercare/continuing care services will be essential within this new service continuum. Both public and private addiction treatment providers will be affected by these expectations.
Providers will also need to demonstrate outcomes which means, they need to have in place an internal quality monitoring program that is based upon measurable quality indicators. The end result, is that program services must extend well beyond the patient’s discharge from the health care provider.
Accountability will take on new meanings and proportions as the affordable care era evolves.