Shifts in the health care industry will have a big impact on employer-provided benefits for workers.
As the industry’s payment model changes, “employers will move to a place where they understand exactly what their cost will be for the year, like the shift from a benefit-based retirement plan to a 401(k),” said Steve Mason, former CEO of BayCare Health System and co-founder of CSuite Solutions, a newly formed advisory firm in Tampa working with health system leaders nationwide.
Mason retired from BayCare, the largest health system in the Tampa Bay area, in 2015. He joined forces with Stewart Schaffer, former chief marketing and strategy officer at BayCare, to form CSuite Solutions. The company incorporated last year and announced its launch in a March 1 press release.
Jim Burkhart, the former CEO of Tampa General Hospital, is one of five additional partners at the firm.
CSuite Solutions emerges as President Donald Trump and Congress work to repeal and replace the Affordable Care Act, the 2010 law that expanded health care coverage. The measure aims to shift the way reimbursements are paid to doctors, hospitals and other providers from a “fee for service” model, where a high volume of patients means more money for providers, to a “value” model, where providers are paid to keep people well and improve the health of people with chronic conditions through evidence-based, cost-effective care.
Even with that goal, “volume is not dead,” Schaffer said.
Many hospitals and practices are still struggling with issues such as reduced reimbursement rates, revenue cycle challenges and declining market share, he said.
“If you don’t have your house in order, it’s hard to make that journey to value,” Schaffer said.
Getting paid for keeping people healthy and improving the quality of care are key to creating a sustainable health care model, Mason said, but will impact providers, consumers, employers and insurers in different ways.
Providers likely will see reduced services. “When a doctor makes a good clinical decision, they will need to make a value decision at the same time. They may not order an extra CAT scan or decide a patient needs to be admitted to the hospital,” Mason said. “All the providers downstream from written orders of the doctors become vulnerable to reduced services and they have to change the way they are thinking about health care.”