Industries
Health Care
Today's health care industry is facing challenges on multiple fronts. Health care providers are confronted with rising costs, increasing demand for services and complex reimbursement and payment systems. MorganFranklin understands the changing dynamics of the health care industry and our expertise allows us to partner with our clients to develop effective solutions to confront the issues they face.
Health Care Reform
President Obama’s landmark passing of H.R.3590 - Patient Protection and Affordable Care Act - aims to make heath care more affordable, insurers more accountable, as well as expands health coverage to all Americans. While this effort aims for broader health care coverage for most U.S. citizens, it is still uncertain how this will impact health care providers and drive down overall costs.
Cost Containment
Employee benefits represent the third-largest expense, behind cost of goods sold and payroll, for most companies. In the next five years it is estimated that health care costs for employers will increase by 50 percent. While health care reform aims to drive down costs, the financial burden for providers, payers and companies will continue to be crippling. For companies this has lead to a shift of cost burden to employees through higher co-payments and deductibles. Some have taken the step of reducing benefits all together in an effort to lower costs. For all players prevention is the focus. Many companies are rightfully introducing programs designed to develop a culture of health through benefits such as on-site health screenings, weight control programs, and physical fitness and stress management in order to decrease long-term cost of care. Prevention and shifting of cost burden may not be enough in today's tough economic times.
Consumer-Directed Health Care
Health care rates are rising at a rate greater than inflation. The trend toward consumer-directed health care (CDCH) is here. Consumers have increasing control over their own health budgets. Employers are moving to high-deductible health plans, personal health care spending accounts, such as Health Savings Accounts, and tiered benefit designs to give employees options. These plans are based on the premise that providing financial incentives to patients will reduce the use of marginal or zero-value services and reduce the overall costs to companies. As patients become more involved in their own health care decisions and exercise greater control over how and when their health care dollars are used, proponents suggest they will look for lower-cost, higher-quality providers, although competition is intended to drive down the overall costs of health care.
Quality of Care and Performance
Americans are beginning to realize that the quality of their health care is often driven by income, insurance status and where they live. The passing of the Patient Protection and Affordable Care Act aims to help fringe consumers that have endured either a lack of access to health care or poor quality of care. However, quality problems will continue to be reflected in a variety of issues including the underuse, overuse or misuse of certain health care services and an unacceptable level of errors. In addition to thinking about the service aspects of care such as wait times and clean rooms, people must consider the clinical quality of care: was the surgery performed properly and were medications prescribed and delivered accurately?
Inefficient Payment and Related Systems
Inefficiency in the health care system is concentrated in the payment flows between consumers, insurance companies and providers. The system lacks the modern convenience seen in the retail sector and is burdened by paper transactions that drive up administrative and transaction costs. In addition, the current health care system is built around “episodic care,” where the payment system focuses on transactions, as opposed to long-term care for chronic conditions. This approach to efficiency in the health care system drives up costs as unnecessary tests and treatments are administered to patients even if they don’t need them.
Data Security and Privacy
Various forces, such as the potential to reduce medical errors and health care costs, are driving the health care industry toward the use of information technology to advance efficiency within the industry. The growing acceptance of Electronic Medical Records and Personal Health Records can improve quality of care and lower costs. However, the importance of privacy and security protection around the electronic collection, use and disclosure of individually identifiable information must guide the adoption and application of this technology. It is important to limit the collection, use and disclosure of personal health information to the extent necessary to accomplish a specified purpose.
Fraud
Health care fraud and abuse are widespread and costly to America's health-care system. All of us everyone is impacted either directly or indirectly in the form of higher health premiums, higher taxes, higher co-payments and reduced benefits. The U.S. health care industry has inherent vulnerabilities that attract individuals or groups who potentially want to abuse the system.
How Can MorganFranklin Help?
MorganFranklin provides a wide range of solutions to help insurers, providers and other third-party providers tackle the challenges facing today's ever changing health care market. From privacy and security to process improvement and internal controls, our professionals have the expertise to help you navigate many of the challenges you face.Explore our capabilities
