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4 key trends for payers and providers in 2022

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Summary

In 2022, the health sector will continue to face operational pressure due to a tight labor market, shifting payer mix, fluctuating volumes due to COVID-19, and rising expenses. Medicaid and Medicare coverage have been incentivized during the pandemic, but when the emergency policies end there will be disruption and payer mix fluctuations. Hospitals will face wage inflation and other cost increases that will squeeze their margins, leading to price increases. Insurance companies have seen a tailwind with fewer non-COVID volumes, but providers face a headwind. There have been fluctuations in Medicaid enrollment, and when the current public health emergency ends there could be another fluctuation. There is also a risk of more advanced and complex illness as people continue to postpone care. The federal surprise billing ban protects patients from sky-high bills, but not all surprise bills are outlawed.

Q&As

What are the key trends for payers and providers in 2022?
The key trends for payers and providers in 2022 are a tight labor market, continued shifts in payer mix, fluctuating payer mix, labor constraints and rising expenses, margin pressure, volume trends, and compliance with the federal surprise billing ban.

How has the COVID-19 pandemic affected the payer mix?
The COVID-19 pandemic has caused an increase in Medicaid and Medicare coverage, as well as fluctuations in enrollment trends.

What are the labor constraints and rising expenses that hospitals are facing?
Hospitals are facing wage pressure due to high demand for clinical staff, traveling agencies luring nurses away with higher pay, and low morale due to burnout. These dynamics have contributed to healthcare workers quitting their jobs. Salaries, wages, and benefits can account for 45-50% of revenues. Hospitals are also facing cost increases in supplies and inflation.

What is the impact of the postponement of care on payers and providers?
The postponement of care poses a risk to payers with a member base that is not only sicker but also has more advanced and complex illness. For providers, the amount of care people postpone more than outweighs what insurers spend on those hospitalized with COVID-19, creating a headwind for providers.

How are providers complying with the federal surprise billing ban?
Providers are complying with the federal surprise billing ban by ensuring patients do not receive these types of sky-high bills that can leave them stuck between provider and insurer payment disputes. However, ground ambulances and urgent cares are not included in the ban, and patients could potentially receive a surprise bill after a lab is ordered by a primary care doctor.

AI Comments

👍 This article provides a comprehensive overview of the current challenges faced by payers and providers in 2022. It is very helpful in understanding the key trends and the potential impact of the pandemic on the industry.

👎 This article fails to take into account the potential long-term impacts of the pandemic on the healthcare industry. It also does not provide any solutions or strategies to address the challenges faced by payers and providers in 2022.

AI Discussion

Me: It's about the 4 key trends for payers and providers in 2022. It talks about the continued operational pressure the sectors will face, including a tight labor market and shifts in payer mix. It also discusses wage inflation, rising expenses, margin pressure, volume trends, and the surprise billing ban compliance.

Friend: Wow, that's a lot of information. It sounds like it's going to be a difficult year for both payers and providers.

Me: Yeah, it does. They're going to be dealing with a lot of challenges like wage inflation, rising expenses, margin pressure and shifts in payer mix. Plus, the surprise billing ban will require providers to come into compliance with the law. It's definitely going to be a tough year.

Action items

Research the impact of the Affordable Care Act on the health sector and the uninsured rate.
Analyze the impact of the pandemic on the labor market and wages for healthcare workers.
Examine the implications of the surprise billing ban on providers and insurers.

Technical terms

Payer Mix: The mix of different types of health insurance plans that a health care provider accepts.
PHE: Public Health Emergency.
ACA: Affordable Care Act.
Fitch Ratings: A credit rating agency that provides credit ratings for companies and other entities.
CreditSights: A financial research and analysis firm.
Unrestricted Liquidity: The amount of cash and other liquid assets available to a company.
Provider Relief Funds: Funds provided by the government to health care providers to help cover the costs of providing care during the COVID-19 pandemic.
Telehealth: The use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely.
Surprise Billing Ban: A law that prohibits health care providers from sending patients surprise bills for services that are not covered by their insurance.