Question
The relationship between healthcare providers and healthcare payers often can be adversarial. Yet, at the same time, a healthy and positive relationship between these two
The relationship between healthcare providers and healthcare payers often can be adversarial. Yet, at the same time, a healthy and positive relationship between these two critical stakeholders is a prerequisite to the overall success of the healthcare triangle. We have discussed numerous tension points between providers and payers during this course, including the impact of certain laws that mandate particular types of relationships (i.e., ACA, EMTALA), payment risk, and the concept of cooperative benefit and network design as a means to reduce the increasing cost of healthcare.Please describe the impact of the soon-to-be-enacted hypothetical FINAL Act (Future Incentives Needed to Advance heaLthcare Act). This hypothetical federal law is designed to change any aspect of the healthcare provider-payer relationship you desire and will go into effect on April 23, 2022. The goal of the FINAL Act is to reduce the overall cost of healthcare while increasing healthcare outcomes.As part of the assignment, please address the following three areas:
- Please begin by describing what aspect(s) of the provider-payer relationship would be changed by your version of the FINAL Act. For example, "changing the contractual relationship of payers and providers by mandating that all providers be contracted with the largest payer in their state" or "changing the way parties negotiate over payment by mandating that every payer publish their rates of reimbursement online."
- Please describe and explain why this version of the FINAL Act mandates those changes. Be sure to justify the position and explain how the changes would reduce overall healthcare costs while also improving healthcare outcomes.
- Be able to differentiate and explain the possible advantages and disadvantages of the above version of the FINAL Act to both payers and providers both in the immediate future and the longer term.
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