EBG Commentary

Jackie Selby Contributes to Population Health News’ “Thought Leaders’ Corner”

Population Health News June 2017

Jackie Selby, a Member of the Firm in the Health Care and Life Sciences practice, in the firm’s New York office, authored an article in Population Health News, in a section titled “Thought Leaders’ Corner.”

Following is an excerpt:

Passage of the AHCA would impact population health management arrangements among providers (such as hospitals) and health plans in several ways. The most predictable impact would be fewer population health arrangements overall because the total insured population is expected to decrease. According to the Congressional Budget Office (CBO), the AHCA would result in 23 million persons becoming uninsured—14 million in Medicaid, six million on exchanges and another three million with employer-sponsored coverage.

For a hospital system or group of providers taking on a full risk-sharing arrangement, population health requires a large enough population to spread insurance risk. Notably, the overall health of an insured population might improve because increased premiums would be expected to force older and less healthy Americans to lose insurance, perhaps improving the performance of risk-sharing arrangements in the short term.

Costs to providers, however, may increase in other ways because those losing insurance might increase the uncompensated care and bad debt of such provider—perhaps back to pre-Affordable Care Act (ACA) levels.

Another impact would be variability in mandated or “essential health benefits” because the AHCA would allow states to waive certain insurance regulations set by the ACA. For example, if a state were to make mental health or substance use disorder benefits optional instead of mandatory, a risk-sharing arrangement could be negatively impacted by increased costs if mental health or substance use disorders go untreated. Increased costs because of decreased benefits would make a population health arrangement less predictable and thus less desirable to providers.