Rory O’Gara of Allianz Partners was at his eleventh ITIC, and echoed the thoughts of many in attendance. “It’s a brave new world in terms of financial, inflation and currency concerns, but there are also high expectations from customers. What we need is an understanding of the pressures on both payers and providers – and it’s key that we learn from each other.”
From a provider perspective, the message was that managing a huge spurt of post-pandemic growth is increasingly challenging, not least because of the staff shortage. This is increasingly prevalent when trying to manage sales on the network side. While the focus is always on cost, the delivery itself is of primary importance, and technological advances are key.
A balancing act
Increasing prices are an inevitability in the current financial climate: “It’s certainly a tug-of-war,” said O’Gara. “Providers have to increase rates to a degree, although in some regions this is done with a lack of consistency. But yes, where exactly is the workforce? It’s difficult to get people in. Also, policies are more complex than ever before, and we need to administer these.”
Elizabeth Boultbee of The London Clinic is bracing for tough business conditions. “We are a large hospital, for secondary and tertiary care, and the costs are going to have a big impact. There’s an anticipation of £6 million alone over the next year, without considering salary and other cost considerations. Looking at efficiencies, there is something about working together. We might have the odd patient every now and then with a portal, so we end up with 50 to 100 portals to administer. A collective approach would be helpful.”
With prices on the up, payment delivery in a timely fashion is more prescient than ever – but cashflow deadlines emerged as a hot topic. Smaller providers are having to wait too long for payments from clients, with the ’30-days’ expectation simply not being met. O’Gara believed teamwork was key: “The insured member presenting at your facility with an insurance card wants to be met with open arms. The system needs to work for insurers and the provider, and it’s vital that payment comes in a reasonable time – as part of the service proposition.”
Attendees expressed the view than a better payment philosophy has been needed for a long time, as there are no real consequences for paying late. Contracts may have 30-days on them, but this is seen more as a ‘target than a hard deadline’. It doesn’t matter if ’30 days becomes 40 days, or longer’. Across small and medium-sized enterprises, cashflow is imperative. “The 30-60 day aspect doesn’t play into people’s minds,” claimed Mark Smith of The London Clinic.
Some providers are looking to offer rewards, with loyalty programmes for those customers of more than a year via cashback schemes.
Question of value
The final topic of discussion related to cost containment via value-based services. From a US perspective, this is a real challenge. New models are being tried, but internal efficiencies are becoming more of a focus, especially on the healthcare side. “Effectively, it’s all about the outcome perspective,” O’Gara said. “As a payer, you look at things like diagnostics and length of stay with value-based services, but what’s key is getting the model to work. Did the member get the right treatment at the right price?”
Mark Smith of The London Clinic had other concerns: “In the UK, we don’t capture the whole of the cost pathway, and you need that to demonstrate real value.”
In conclusion, the ever-changing political and financial landscape is putting pressure on the whole provider network – but solutions are at hand.