The New Rules That Could Change the Way You Get Healthcare: Industry Analysis from Loyale Healthcare

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Americans are worried about healthcare and their elected representatives are doing something about it. From surprise medical bills to price disclosure to pharmaceutical costs, a raft of proposed legislation could have a major impact on healthcare providers and their patients.

As with other sectors of the economy, the healthcare providers that deliver what their customers perceive to be superior experiences and value will prevail - Kevin Fleming, CEO, Loyale Healthcare

According to this Gallup poll from late 2018 and almost every other national research poll on the concerns of American voters, healthcare ranks as the number 1 issue. Of course, healthcare is a complex, multifaceted issue. So voter concerns cover a range of issues including cost, quality and availability of care. The availability of insurance and coverage of pre-existing conditions are also cause for voter concern. The issue was recently given even higher visibility by an announcement that president Trump will soon issue an executive order mandating improved pricing disclosure in healthcare.

This heightened interest has been spawned in large part by the fact that, for more and more Americans, healthcare has become increasingly inaccessible. This compromised accessibility is largely attributable to cost. Costs that even the insured, many now in high deductible health plans (HDHPs), struggle to afford. Whether or not one subscribes to the notion that healthcare should be a right, this cost-induced concern is at the top of voters’ minds, and on the agendas of the policy makers who serve them. The objective: an American healthcare system that brings care within financial reach for all Americans.

The conviction that healthcare should – and could be – more affordable for more Americans, is our passion at Loyale Healthcare. Loyale was conceived with a vision for the future of healthcare. A vision that imagines fiercely loyal patients as a healthcare provider’s most precious asset and the source of its business success and growth. We’re proving every day that by delivering more consumer-friendly experiences to their patients, providers are seeing improved efficiencies and better financial outcomes.

Whether or not one agrees that additional regulations are the best solution to the healthcare issues concerning Americans, it’s clear that more regulations are on their way. For industry innovators who lean in to these changes, we believe the prospects for longer-term success are promising, even groundbreaking. The challenge is finding the right partners and technology to make the necessary adaptations quickly and without undue disruption.

Currently, there are 531 bills in Congress that reference health or healthcare. Few will receive the bipartisan support necessary to move them through Congress. Perhaps fewer will be signed into law by the president. Any way you look at it, the intense national spotlight on an issue that affects every American family is likely to yield some significant change. Here are four bills that might have a chance of enactment and one whose chances we believe are slim to none.

5 Key Healthcare Issues Pending in Congress

1. Patient Engagement and Disclosure: Many proposed bills and the above mentioned executive order are focused on the disclosure of cost and financial information to the patient, as well as the relationship between the patient, provider and the insurer; details which up to now have not been transparent or collaborative.

Cost disclosure has received a lot of focus from both the legislative and executive branches. The fact that patients do not receive upfront cost information impairs patients’ ability to compare providers and the costs of alternative treatments. The executive order is likely to be focused on lowering health-care costs by giving consumers and employers data for the first time on the discounted and negotiated rates between insurers, hospitals, doctors and other providers.

Legislation in Congress is focused on “surprise” medical bills. These are unexpected bills in which a patient unexpectedly finds one or more of their medical service providers is out-of-network and is therefore not covered or only partially covered, resulting in extraordinarily high costs.

Senate Bill 3592 would take the patient out of the negotiation between the provider and the insurer. Proposed by Senators Cassidy and Hassan, this bill is fairly comprehensive in terms of addressing the surprise medical bills issue. A stumbling block is the provision that this bill would set payment rates for non-network providers and appears to face some opposition by the American Medical Association.

The House “No Surprises Act” version of the Senate bill, sponsored by Representatives Pallone and Walden, is similar to the Cassidy/Hassan bill but has fewer protections for the consumer and thus perhaps will face less opposition by the medical industry.

Neither of these bills addresses the adequacy of the insurance network system or level of care provided by out of network providers.

2. Drug Pricing: The Lower Healthcare Costs Act, sponsored by Representatives Alexander and Murray is focused on drug pricing and price transparency. This bill would attempt to address rapid and significant drug price increases which have occurred in the last few years, particularly where the drug is unavailable from other drug companies. Also of concern is the practice of drug companies paying generic drug companies to keep the generic version off the market so that the price can stay high in the market.

Further along is Senate Bill 340, sponsored by Senator Leahy, which would promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and bio similar versions of those drugs and biological products.

3. Health Insurance Coverage: This bill is entitled the Marketing and Outreach Restoration to Empower Health Education Act of 2019 or the MORE Health Education Act and is sponsored by Representative Rochester.

This bill requires the Department of Health and Human Services (HHS) to conduct outreach and educational activities regarding federally facilitated exchanges (i.e., health insurance exchanges that are established and operated within states by HHS). The activities must inform potential enrollees of the availability of coverage and related financial assistance under the exchanges and must be provided in culturally and linguistically appropriate formats.

4. Pre-Existing Conditions: A bill directed at preserving the preexisting condition provisions of the Affordable Care Act is H.R. 986 Protecting Americans with Preexisting Conditions Act of 2019. This bill nullifies the Department of the Treasury and the Department of Health and Human Services guidance titled "State Relief and Empowerment Waivers," published on October 24, 2018. The guidance pertains to waivers (also known as State Innovation Waivers or State Relief and Empowerment Waivers), which allow states to forego certain requirements of the Patient Protection and Affordable Care Act in order to implement experimental plans for health care coverage, as long as the resulting coverage meets certain statutory criteria. In essence, this bill preserves the preexisting condition coverage of the ACA.

5. Medicare for All: Several proposals in the House are focused on extending Medicare to all Americans. This issue has become a focal point among democratic presidential candidates in the 2020 presidential election. House bill 7339, introduced by Representative DeLauro, would amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans. Clearly lacking bipartisan support, this bill has a low chance of passing and likely is “dead on arrival” in the Senate.

With 531 bills introduced in the Senate and House related to health and healthcare, it is difficult to predict how many and which particular bills will make it through the Democrat dominated House and the Republican dominated Senate and forward to the President. But it is without doubt that healthcare will remain the number one issue affecting our aging U.S. population.

At Loyale, we believe that voter concerns and subsequent proposed legislation point toward the necessary evolution of the American healthcare industry. The industry that emerges from this period will face the same market pressures affecting nearly all sectors of the economy. But, as with other sectors of the economy, the providers that deliver what their customers perceive to be superior experiences and value will prevail. Our company, Loyale, was conceived to help accelerate that transition to the benefit of our provider partners and the patients they serve.

Kevin Fleming is the CEO of Loyale Healthcare

About Loyale

Loyale Patient Financial Manager™ is a comprehensive patient financial engagement technology platform leveraging a suite of configurable solution components including predictive analytics, intelligent workflows, multiple patient financing vehicles, communications, payments, digital front doors and other key capabilities.

Loyale Healthcare is committed to a mission of turning patient responsibility into lasting loyalty for its healthcare provider customers. Based in Lafayette, California, Loyale and its leadership team bring 27 years of expertise delivering leading financial engagement solutions for complex business environments. Loyale recently announced an Enterprise level strategic partnership with Parallon including deployment of its industry leading technology to all HCA hospitals and Physician Practices.

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