Author: Dorron Blumberg

During a recent Town Hall meeting of the Dade County Medical Association (DCMA), physician frustration with continued reimbursement challenges from insurance carriers boiled over into a lively and highly productive conversation. The focus on the discussions related to the Medicaid Managed Care Program and the Enhanced Payment Program which when fully implemented will guarantee Medicare level reimbursement for all in-network physicians providing services to pediatric Medicaid Beneficiaries. 

From a financial and revenue perspective, there are several competing factors that go into running a successful non-profit health care system while also meeting the growing and varied needs of patients. With a budget of $1.2 billion, Broward Health is one of the largest public health care systems in the nation and, as with any organization of this size, we face a myriad of challenges.

Insurance underwriters use simple loss ratios (losses and expenses divided by premiums) as one of the tools with which to gauge a company’s suitability for coverage. High loss ratios, in which the losses approach, equal, or exceed the premium, are not good. One factor that has a large effect on loss ratios are “shock loss” claims, catastrophic losses so large that they have a material effect on the underwriting results of an entire insurance company.

It’s been said the only constant is change, but when it comes to telehealth, change has been taking steroids. Enabled by a healthcare industry looking to better serve patients, protect its bottom line, and desired by an increasingly technology-addicted customer base, delivering clinical services without an in-person visit has gone from barely on the radar to potentially revolutionizing the delivery of care within a generation.