The Supreme Court’s decision to uphold the ACA made it all but certain that targeted reimbursement reductions are on the horizon. The law created the Independent Payment Advisory Board (IPAB) with a mandate to drive down healthcare costs. With the power to modify reimbursement rates and requirements as their principal tools, providers can expect both lower payments and decreasing volumes of high-margin services. At the same time, CMS and commercial payers are actively exploring new care delivery and payment models including ACOs, bundled pricing, and pay for performance. To top it all off, consumer and payer interest in the cost and quality of care is growing as new transparency requirements mandate the reporting of outcomes and premiums rise.

All these demands point to the need for a fundamental transformation in how we deliver care, refocusing efforts toward “better care at lower cost.” Providers can anticipate particular scrutiny on the payments for traditionally high-margin, high-volume services and need to prepare accordingly. Healthcare delivery organizations must make the care they deliver more efficient, or risk their financial solvency. Provider organizations will need to capture and analyze integrated cost and quality data, structured to provide insight into improvement opportunities. Success requires a level of clinical and financial data integration that is new for the industry.

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