Surfing the patient tidal wave

Consider this: From 2008 through 2014, Massachusetts was the only state with an uninsured rate lower than 5 percent. Today, at least seven states boast uninsured rates at 5 percent or below: Rhode Island, Massachusetts, Vermont, Minnesota, Iowa, Connecticut and Hawaii. Nationwide, the uninsured rate is less than 12 percent – and this will continue to decrease in the months ahead, thanks to an initiative by The U.S. Department of Health & Human Services (HHS) targeting several states for increased healthcare exchange enrollment in 2016. Texas tops HHS’ list with the highest uninsured rate in the country at 20 percent.[1]

Shrinking uninsured rates have significant implications for provider organizations as they move to a value-based care model. These organizations can expect a tidal wave of new patients coming to their facilities. They must find a way to improve quality and reduce costs while, at the same time, preparing for an influx of chronic patients with significant and lengthy gaps in care.

Newly insured patients, many of whom had forgone preventive and chronic care prior to gaining insurance, require outreach – for routine care, such as immunizations, screenings and wellness visits – as well as systems of management for those suffering from one or more chronic conditions. Providers in Texas, and any state where HHS’ efforts to increase healthcare exchange enrollment bring on a sudden surge of new patients, will need to quickly build scale and capacity so as not to disrupt their practice and burn out staff. 

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