ASCs should anticipate growth in hospital-owned insurance plans and retail medicine, according to Regent Surgical Health CEO Chris Bishop.
Mr. Bishop explained the trends in a recent post:
1. Hospitals as insurers. In the past five years, many major health systems have been investing in, creating and acquiring insurance plans, according to Mr. Bishop. He expects to see an increasing prevalence of health systems becoming payers. He has also seen health systems assuming shared risk with payers, with a focus on improving value. This trend will make it important for ASC leaders to understand payers, and particularly health system-owned ones. ASCs considering a hospital partner will need to consider how many lives the hospital's insurance plan covers and weigh potential conflicts.
"In the past, we didn't factor that into our decision tree when we were selecting hospital partners to join us as partners in our centers," Mr. Bishop said. "Now you have to be thoughtful about which health system you ask to invest because while you may invite one health system that brings covered lives that you couldn't currently treat, you could stand to lose another contracted health system's covered lives."
2. Retail medicine. The transition toward health savings accounts and high-deductible plans drove patients to demand care in the most cost-effective setting. Moreover, employer-owned health plans at companies like Apple, Amazon and Walmart incentivize employees to seek surgical care in lower cost, higher quality settings. Providers must now view patients as "discerning consumers who will shop around," according to Mr. Bishop.
"That was rare five years ago, but now that a patient could pay as much as $10,000 of their deductible, cost is a greater consideration. If a routine colonoscopy costs $3,000 at the hospital but just $1,000 at a surgery center, that's an easy choice," Mr. Bishop said.