Managed Care Advisor spotlights Eric C. Rackow's expert comments on how healthcare reform impacts our health system

 Managed Care Advisor - December 2, 2010 - The sheer scope of The Patient Protection and Affordable Care Act (PPACA) guarantees that providers will see changes to managed care arrangements, notes Eric Rackow, CEO of SeniorBridge, a New York City-based company providing case management services to providers across the country....

The health reform law will produce a rapid change in the way healthcare is delivered in the country, he says.

"We will see a shift in the health plans, the hospitals, the industry at large, in how we manage patients," Rackow says.

"The need for this change has been known for a long time, but practice tends to follow reimbursement, and there will be some real changes in reimbursement."

For starters, providers will be pressured to reduce rehospitalizations through bundled payment legislation (2012 for Medicaid and 2013 for Medicare) and penalties for preventable readmissions (2012). Rackow suspects that health plans will soon follow by requiring the same sort of improvements when contracts are renewed.

"The government is setting up certain standards as the way healthcare providers will be expected to provide cost efficient, quality care, and managed care entities are going to pick up on that and impose their own version of those same standards," he says.

"Look at what PPACA is doing now with Medicare and Medicaid, and you can see what likely is going to happen with managed care as well."

"I think you will see increased pressure to have bundled payments, to take care of people over a period of time instead of episodically," he says.

Some lawmakers and payers have considered a plan for bundled payments in which, instead of paying a hospital just for the specific hospital admission, they would be paid for the three days before and the 30 days after, Rackow says. So if a patient gets readmitted during that period, there is no additional reimbursement from Medicare or the managed care entity.

"What's going to happen in managed care and Medicare is that they will not pay for readmissions that are unnecessary. They will bundle the payment for the patient, so you have an incentive to coordinate care and make sure that patient doesn't get readmitted unnecessarily," he says. "That would be a major change in the way payment is provided."

So what can you do now to prepare for that kind of dramatic change?

Rackow says you should start to organize your operation to provide care coordination when the patient is at home in order to prevent that person from being readmitted.

"One way to do that is to use care managers to do care coordination at home, making sure the person understands the medications they're taking, that they're taking the medication, and that they have food and water in the home," he says. "We're going to see a real difference in how we handle patients after they walk out the door, because there will be a strong incentive to keep that patient from coming back to the hospital or the physician practice for additional care."