Coming on January 1st:
At least 2.2 million (some estimates are as high as 6 million) people will lose their ACA Marketplace health insurance as premiums increase an average of 114%. Many others will accept poorer coverage and higher deductibles.
Another 1.3 million people will lose Medicaid coverage due to the elimination of ARPA expansion funds.
By 2029, the Congressional Budget Office projects that 12.4 million currently-insured Americans will have lost their health insurance:
It’s conceivable that Congress will surprise us all and work across the aisle to fund the expiring ACA credits. However, it looks pretty unlikely to me. (Not that my opinion means much – my insider knowledge of Congressional maneuvering ended almost before it began, when I lost my 2004 race for Colorado’s Congressional District 6 seat).
It’s a safe assumption that the next several years are going to be tough. Fortunately, there are proactive steps you can take now to protect your company and potentially even increase your income. Vista Research clients who are already investing in outcomes research have a leg up on implementing these strategies, but the general ideas are applicable to any effective treatment center.
Broadening Your Revenue Sources & Cutting Customer Acquisition Costs
Perhaps the most important thing you can do is to figure out how to attract more patients inexpensively. Here are some options:
Attract more highly-motivated self-pay clients
Regardless of what happens to insurance, the demand for effective treatment isn’t going to do down. In fact, I expect it will go up over the next few years as the fall-out from the tariffs and the spending cuts directed at all of us non-billionaires causes the economy to flounder.
Whether they have insurance or not, families with a loved one at risk of dying due to their substance use will desperately want to get them into treatment. Their options will be similar to those that families like mine encountered in the years before Obamacare was enacted – since insurance wasn’t going to pay a dime for addiction treatment, we had to somehow find the money to pay for it ourselves.
Many families (perhaps most?) won’t be able to do so, but those who do will be highly motivated to find rehabs which can prove that their treatment works. Centers with an independently-verified rating on Conquer Addiction will be at a significant advantage as this Google search result, appearing in the fourth spot on page 1, shows:
Centers which are part of the Five-Star Addiction Treatment Market will particularly appeal to families. In addition to setting all-inclusive pricing, these centers have promised that if a patient relapses within 90 days of completing their program, the patient can return to treatment for free.
Expand your payer base (including among employers in your area) by using hard data to showcase how effective your treatment is
Meadows Behavioral Health just released a spectacular Outcomes Report that does exactly this. If you’re looking for ideas, you can download it here.
Apply to join Carrum Health’s SUD Center of Excellence program
To become a preferred treatment provider for employees of large national companies like Lowe’s and United Airlines, you can apply to join Carrum Health’s Center of Excellence program. As Carrum’s Certifying Agency for this program, Vista can help.
Renegotiating Reimbursement Rates
Use your outcomes and price transparency data to renegotiate reimbursement rates with your largest payers
Vista's Payer Summary Reports provide the independent data you need to prove how effective your treatment is to payers. They are apt to find Vista’s analysis showing how much the payer saved in post-treatment medical interventions particularly compelling:
In addition to outcomes, you will also benefit by knowing how your reimbursement rate compares to what the insurer is paying similar centers in your area. If you’re interested, we can connect you to firms specializing in price transparency work that can help you prepare for an effective negotiation.
Yes, the next few years are going to be tough. But there are proactive steps you can take now to broaden your revenue sources and negotiate higher rates with your key payers.
Over the last couple of years, I’ve watched in horror as several excellent treatment centers have been forced out of business. I want to do everything I can to avoid watching it happen again.
If you’d like to talk privately about the challenges your company is facing, please reach out. Perhaps we can come up with some helpful ideas.