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Medical Agency's Growth Opportunities for 2019

Updated: Sep 26, 2018

“A survey of Medicare Advantage health plans operated by both health insurance companies and health agencies shows that only 31% of them have identified solutions to help them assess the quality of their post-acute provider network.“ Source: Healthleaders Media News

Patients are demanding quality-based care and have a greater number of choices to make about the type of post-acute medical care they receive.


Healthcare Industry Challenges for 2019: A year for resilience amid continued uncertainty

"Health reform isn’t over, is it ever?

Directly or indirectly, health reform will impact your business. The Centers for Medicare & Medicaid Services proposed HHA rule legislations include a change in the unit of payment from 60-day episodes of care to 30-day periods of care, to be implemented January 1, 2019. Latest information on this policy change is that 2020 is more likely. This will have an impact to a HHA’s bottom line.


These and other changes will continue in 2019 as Policymakers at the state level may be making key decisions if many healthcare reforms are enacted.


The trend this year has also been toward state autonomy in healthcare policies. Healthcare companies, particularly those that operate in multiple states, should bolster compliance and local advocacy efforts. It is imperative that they understand fixed costs and federal and state policy decisions’ impact on gross profit margin.


2019 is the year of the Strategic Patient Experience


With the federal government ramping up reviews of Medicare Advantage plans for adults before they hit 65, healthcare companies should begin preparing.  To avoid costly penalties, Health Insurers should focus on patients, such as timely member notifications, and provide an adequate network with accurate provider directories. Healthcare Agencies should plan for increased administrative burden and clinical staff workloads.


“73 percent of provider executives say balancing patient satisfaction and employee job satisfaction is a barrier to efforts to improve the patient experience. The Cleveland Clinic saw major improvements in patient experience measures after conducting programs to engage employees in the mission of caregiving." Source: PwC Health Research Institute.

Current Medical Agency Challenges

Home Healthcare

The home healthcare industry is booming right along with baby boomers but face formidable challenges next year.  State and federal governments are looking to appropriately regulate home care agencies.  This will be a challenge as some agencies provide only skilled medical services, while others provide non-medical care (or both).  It will be a difficult balance for legislatures as they consider regulations that would benefit those receiving care but not restrictive for those providing it. 


For a Home Healthcare Agency, finding patients and new referral sources is a top priority when planning sales and marketing initiatives. Nurse staffing challenges prevail in managing existing coverage or expansion into new areas.


Among these challenges, existing home health agencies have the great advantage of remaining profitable given the climate.  Existing home health agencies should maximize their competitive position by getting a better sense of what their patients want and need, while enhancing their current training program for current and future caregivers.

Hospice

In light of rising numbers of individuals accessing hospice in the U.S., Hospice agencies should be well positioned for growth. To ensure profitable growth, companies will need to focus on easing administrative burdens, reducing complexity and clinical staff workloads, and enhancing the patient and family member experience.


Like Home Healthcare, finding patients and new referral sources is crucial. From an operational perspective, retaining Liaisons with incentives and loyalty programs is an ongoing issue.


Medical Agency opportunities in 2019


Facing stagnant revenue and increasing expenses, Medical Agencies are cognizant of their shrinking gross profit margin. With low barriers to entry, Agencies have to address increased agency competition.  External impacts from emerging medical technologies and government regulations all impact top-line revenue. Company expenses have increased from staff recruitment and training and state employment taxes.


To capitalize on new sale opportunities, companies purchase expensive medical data and analytical services. With this target medical market data, they may be forced to invest capital into hiring more liaisons or contract field medical reps.


"30% of my sales and marketing dollars are wasted, I just wish I knew where”

The first question an Agency should ask is “how much do I make per patient”? Uncovering this key metric will address the factors that improve and negate your profit margin.


Final thoughts


As a business owner, this may seem like a daunting task given that many started their business with the promise of providing quality based patient care.  A volatile competitive landscape and ever revolving legislation could provide new opportunities for those Agencies that are both hungry and ready to embrace these changes. 


With the onset of AI and IoT, innovative technology opportunities will continue to becoming available. Medical Agencies that are open to new technology partnerships, that disrupt standard medical sales and marketing tactics, are poised for success in 2019.


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