Anthem BlueCross BlueShield recently announced it will no longer pay for fully insured members to receive certain outpatient imaging services in a hospital setting. For healthcare marketers, the move further underscores the growing need for marketing analytics and targeted communications.
The Anthem policy change affects reimbursement for outpatient, hospital-based magnetic resonance imaging (MRI) and computed tomography (CT) scans. The change recently took effect in Indiana, Kentucky, Missouri, Wisconsin, Colorado, Georgia, Nevada, New York, and Ohio, and by March 2018, the policy will be in effect in all states that do business with Anthem—with the exception of New Hampshire—according to a Modern Healthcare article.
Here are a few frequently asked questions about this change in policy and its potential impact on healthcare organizations.
Q. How will this change in policy affect hospitals and health systems?
Generally speaking, between 35 and 60 percent of hospital income is derived from imaging services overall (includes CT, MRI, and other diagnostic procedures). How large of a market share Anthem has in a hospital’s market will drive the implications of this policy. If you’re in a market where Anthem has a significant percent of the insurance space, you’re at risk of losing that percentage of your profits from the imaging side.
Q. What types of tough decisions do you foresee hospitals, especially rural hospitals, having to make in light of this policy?
As people continue paying more healthcare expenses out of pocket due to high deductible health plans, they will move from higher-charge environments to more consumer-driven approaches—like outpatient imaging—that are going to drive commercial insurance volume away from hospitals.
Anthem’s move to redirect patients from hospital-based MRI and CT imaging services to lower-charge settings will continue to pressure health systems’ financial performance. At some point, for smaller hospitals, this may mean the difference between staying open and closing. It will certainly cause hospitals to reassess their staffing capabilities and their service line mix.
Q. What potential challenges and opportunities does this policy change present for healthcare marketers?
Today, many healthcare delivery systems are pursuing value-based, quality-driven, integrated models of health care. A key component of that is having your patient population use in-network services so the hospital network has oversight of quality and utilization, as well as effective communication between the different components of the delivery system—whether that be inpatient, outpatient, or post-acute care. If the care provided is not kept within that hospital or health system network, advancing population health models becomes more challenging.
The potential for fragmented care is very real, and if care remains fragmented, it makes it very difficult for hospitals to ensure quality outcomes. The challenge for marketing leadership is to drive the importance of this to their communities, patients, and providers. Someone has to help script and communicate that message so everyone within the organization is on the same page.
Additionally, this highlights the need for marketers to understand healthcare finance and reimbursement and presents an opportunity for marketing leadership to get close to the financial leadership of the organization. Once you start to understand how these structural changes in reimbursement will impact your organization, you start to understand how to more effectively help support your organization.
Q. How can healthcare marketers address these challenges through marketing analytics and targeted communications?
Understanding the marketing analytics of the imaging service and payer mix is critical. This means answering the questions: What Anthem patients are coming to your organization for imaging? Why are they coming? What’s the downstream service that they’re having, and what’s the outcome?
You need to understand the whole anatomy of the service to see how and where you can intervene to have an impact. If you want to be the most effective, you need to make sure you’re going out there with the right communications for the right audiences.