Many injured workers require diagnostic imaging, which must be assessed by qualified professionals. Unfortunately, the Association of American Medical Colleges projects a shortage of as many as 43,000 radiologists and other associated specialists by 2033. Credit: TonStocker/Adobe Stock
As the coming year approaches, it's clear managers of health care provider networks face significant challenges, including managing a growing shortage of physicians, increasing need for mental health coverage and changing state fee schedules and physician fee models.
To meet these demands, managers will need to think creatively and begin taking measures now to ensure their networks are healthy and able to provide patients with cost-efficient, high-quality care.
Let's take a look at some of the major challenges in more detail.
Physician shortages: According to the American Medical Association (AMA), the U.S. will face a shortage of up to 124,000 physicians over the next 10 years. The worst shortages will occur in primary care, which could see a shortfall as high as 48,000 providers. In fact, the health care industry is experiencing staffing shortages across the board, not just for those providing direct services to patients. The "Great Resignation" hit the medical field hard. The stress of the pandemic, lack of work-life balance, increased workloads, burnout and lack of compensation to meet this demand have caused many providers to consider other areas of employment.
P&C networks mostly consist of specialty professionals, so the primary care provider shortage shouldn't have the same impact on our industry as other areas of health care.
However, specialty services are not immune from current medical staffing challenges. AMA projects a shortage of 30,000 surgical specialty physicians by 2034. This group includes orthopedics, a leading provider service in workers' comp. When paired with an aging population needing additional services, access to care issues will become more prominent.
To address this problem, some states have changed their regulations to allow physician assistants (PAs), nurse practitioners (NPs) and other non-physician providers to provide primary care. These mid-level providers can certainly improve access and help manage less severe cases, but network managers will need to ensure these professionals are qualified per state requirements.
Mental health services: Access to care is also a major concern in mental health. Nearly half (47%) of U.S. residents live in an area without enough mental health providers, according to the Health Resources and Services Administration. Just as some states now allow PAs and NPs to provide primary care, others have begun allowing or are considering using clinical social workers to provide primary mental health services.
Diagnostic imaging: Many injured workers require diagnostic imaging, which must be assessed by qualified professionals. Unfortunately, the Association of American Medical Colleges projects a shortage of as many as 43,000 radiologists and other associated specialists by 2033.
What's more, while the need for imaging in the U.S. is growing by 5% each year, radiology positions are growing by just 2%. Studies show that the longer it takes for a radiologist to review images, the longer patients are likely to remain in the hospital.
Fee changes: While adapting to annual changes in state-mandated fee schedules and rules presents its own challenges, P&C professionals are also working to integrate prospective payment programs and performance-based models. Ultimately, these changes are likely to result in better outcomes for patients, but they will require network managers and payers to make significant adjustments to their plans.
Physical therapy: Access to specialty services, such as physical therapy (PT), is an area of particular concern for P&C professionals. PT professionals frequently play a major role in patient recovery following injury or surgical procedures, guiding therapy targeted to help individuals get back to work and function.
PT also typically requires multiple visits per week over a long period of time. As with radiology, limited access to PT services delays treatment, lengthening recovery and return to work.
Meeting the Challenge
There is some positive news, however. Health care technology is advancing rapidly, increasing efficiency improving outcomes, and mitigating some of the effects of the imaging professional shortage. Artificial intelligence (AI) is already being used by imaging professionals to help analyze radiological images, improving accuracy and speed.
Mobile diagnostic imaging services are also becoming more common, allowing for greater access to care. These services can help reduce delays in imaging and eliminate the need to transport patients to a medical office. It also decreases the rate of missed appointments.
Kate Farley-Agee of Coventry, an Enlyte company. Credit: Courtesy photo Managing these changes adds a great deal of complexity to an already complex task, and filling the inevitable gaps these shortages will cause will be difficult. Partnering with an existing provider network can help fill those gaps and ensure the network remains stable and secure.
Additionally, these networks make keeping up with changes in local laws and regulations a priority. It's an enormous job that requires dedicated attention to many different moving parts. Mistakes can result in delays in payment, inaccurate payments and even penalties.
The coming year presents significant challenges for provider services. However, by partnering with a network that maintains strong, trusting relationships with current providers and integrates creative solutions to ensure access to care, P&C professionals can better manage costs while improving outcomes for injured individuals.
Kate Farley-Agee is vice president, product management for Coventry, an Enlyte company, overseeing the company's product strategy for the national broad-based provider solution, custom provider networks, and certified state programs across the country. She has almost 30 years of experience in the health care industry with an emphasis on managed care, network development, product management, provider relations and leadership in group health commercial and property and casualty lines of business.
Opinions expressed here are the author's own.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.