Health Economics and the Reimbursement Landscape in Healthcare

Jul 6, 2017

The uncertainty in the United States healthcare market has made it rather imperative for the medical practitioners and service providers to understand the nitty gritty of the evolving reimbursement landscape. While traditionally the focus of manufacturers remains on getting regulatory approval to push their products in the market, the scenario has changed hugely in the past five years. Today with an increase in patient access, it is not just the physicians but other stakeholders like health care organizations as well as the insurers who decide the future of drugs and medical devices.

Influence of the latest trends in the healthcare landscape

The emergence of bundled payments, tiered narrow networks, along with high demand for price transparency from the patients’ end are some of the major trends which the healthcare sector is witnessing now. These trends are sure to impact reimbursement programs like ASC (Ambulatory Surgical Center) Payments. It is therefore critical for ASCs to optimize their payment strategies to protect their financial footing.

Similarly, patients are no longer just a group of end-consumers in the healthcare industry. Rather the patient community has emerged as a financial class which demands transparency in pricing and are forming pressure groups to prevent surprise billing. Only last September, the California Health, and Safety Code was approved which mandates the providers of out-of-network at in-network facilities to treat patients as if they are part of the network itself.

Another critical element which is changing the face of the reimbursement landscape is the bundled payments system. According to one of the latest studies conducted by ORC International, by the year 2021, 17 percent of reimbursements will take place in the form of outsourced bundled payments system. This means that reimburses like ASC must collaborate with the third-party providers of the payments system to stay relevant in the competition.

Infiniti’s take: Health Economics to the rescue

The basic premise on which health economics works is improving the overall delivery of the healthcare services without any major spike in the health care costs. One of the best ways in which this can be attained is by integrating the healthcare services and the reimbursement process seamlessly. The therapies, be it traditional or innovative ones, should be aptly targeted to improve the clinical outcomes as well as optimize the healthcare costs.

Experts in health economics believe that changes in the commercialization strategy by integration of new therapies is sure to improve the overall reimbursement landscape. This can be possible only if there is a nuanced understanding of the clinical conditions, related treatments, and the most appropriate healthcare delivery model.

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