Electronic Health Reporter

Milton Silva-Craig, president of TransUnion Healthcare, discusses his thoughts for the future of healthcare, payment reform, new patients and financial pressures in the reform era and changes he sees on the horizon.

How has the role of data analytics changed in the healthcare industry, especially in light of the ACA and reform?

It is no longer a nice tool to have at your disposal. It is a requirement. It is the foundation necessary to support the outcomes of reform. Moving forward, reimbursement will be tied directly to outcomes and performance. The only way to measure such performance will be through the use of data. It will be the insights gleamed from the data that will allow providers to be successful in managing the intersection of patient care and a healthy business.

With complexities, such as an influx of newly insured patients, impacting the healthcare system, how can IT solutions mitigate pressure on existing systems, as well as enhance new ones?

The success of reform is integrally linked to and dependent upon healthcare IT. From deciphering complex benefit plans so as to yield accurate patient estimations; to finding coverage for eligible patients; to facilitating pre-authorization and medical necessity; to tracking care protocols in patient and member populations; and to tracking disease registries for specific reimbursement . . . healthcare IT will be a linchpin to the financial success of a provider.

Describe issues you see with healthcare payment reform, and provide insight into what can be done to ease the transition to new methods such as bundled payments.

The fundamental issue rests in the complexity associated with future payment models. You couple concepts like bundled payments, increasing patient out of pocket responsibility and reductions in disproportionate share payments, just to name a few . . . and you get a witches brew of complexity. Relative to easing the transition, Providers should be proactive in analyzing whether they have the tools necessary to deal with these complexities. A lot of time and effort has been spent over the past several years in the deployment of EHRs. We believe the next several will be consumed with addressing a changing reimbursement landscape. Current RCM systems, which have been in place for as long as 10 years, are not equipped to deal with these market changes.

Integrated into these issues, is that providers have not heretofore dealt with this level of complexity with respect to reimbursement. Consequently, understanding how these reimbursement models impact their profitability is yet another unknown.

Given your knowledge of healthcare costs and consumer credit, can you elaborate on the healthcare credit payment crunch, and how consumers can effectively manage their revolving credit to afford healthcare?

The issue is one of education, not more effectively managing their revolving credit.  Consumers of healthcare, you and I, and providers, must engage in greater transparency with respect to a patient’s responsibility. We must, as an industry, remove the layers of obfuscation that have clouded an important conversation – how much does it cost and what is my responsibility. Consumers of healthcare are generally not familiar with their benefits plan – co-pay, deductibles, co-insurance, max out of pocket, etc. With a greater understanding of the benefits structure and greater transparency relative to the cost of the procedure, a patient and provider can engage in a meaningful discussion on how best to manage the payment process.

With an influx of newly insured patients entering the system, and new financial challenges, such as bundled payments and quality care reimbursement on the horizon, how will IT tools impact the ease of the reform implantation process?

Briefly discussed in question #4, but there are additional technologies that can assist with these changes. To name a few, a data driven, automated platform for managing the patient access process – identity and demographic verification; eligibility verification; patient responsibility determination; eligibility assistance for Medicaid and hospital charity programs; contract modeling systems that decipher complex payment plans into real-time reimbursement information (including bundled payment analysis).

How do you see healthcare systems managing both new patients and financial pressures in the reform era?

I anticipate it will be very challenging. Uncompensated care is a real issue for providers ~ greater than $40B annually and growing. Patients are managing greater financial responsibility, which increases pressure on the hospital to ensure they collect from the patient. Reimbursement pressure, coupled with increasing costs (salaries, services, et al.) further compounds the problem. One of the top issues for hospital CEOs and CFOs is financial performance.

How do you see the field changing in the near term?

Out of the gate, I see a similar situation to now. We do not anticipate a massive influx of new enrollees, per challenges and delays with getting people to enroll. The plans that will be offered (bronze, silver, gold and platinum) have wide variability and include forms of deductible. This bundled payment framework will be in its infancy. This will take a few years to roll out until we have a better feel for the impact.

What are you hearing/what feedback are you receiving from professionals in the field about this issue?

General concern. A strong sense that the problems will get worse before better. Certainly a belief that opportunities exists to better manage and deliver their service, but uncertainty remains.

How does TransUnion best serve this space and why is it a right fit?

If you fundamentally believe that consumers will play a greater role in the financial management and responsibility of their healthcare then what better place for an organization like TransUnion, that at its core understand consumer financial behavior, to assist both patients and providers. Today we help more than 500 hospitals and thousands of physician groups better manage the financial payment process. We believe we are well positioned, in a market that is undergoing massive upheaval with respect to reimbursement, to take a leadership role from a consumer-centric perspective in helping our clients manage through this change.

Milton Silva-Craig is president of TransUnion Healthcare, LLC. Silva-Craig is responsible for the strategic direction of the business and expanding its footprint in the healthcare market overall. Silva-Craig joined TransUnion from software and services healthcare provider Technology Solutions Company, where he served as president and Chief Executive Officer. He previously served as president and Chief Operating Officer of Emageon Inc., a diagnostic imaging information technology company. He also served as an executive with GE Healthcare in its information technology business unit.