As a medical credentialing professional, what’s your takeaway from this chart, with data furnished by a Kaufman, Hall & Associates survey and report?
For most of the last decade, healthcare mergers and acquisition activity increased, aside from a blip in 2016. Many deals are mega in size, involving sellers with net revenue of $1 billion or greater, according to the survey, with resulting organizations growing larger to thrive or survive. Meanwhile, since 2010, nearly 90 rural hospitals have closed and many more are at risk of doing so.
Mergers and closures can create all kinds of ripple effects in an industry. Common assumptions are that downsizing will occur in the pursuit of efficiencies and some jobs (and whole job types) will be eliminated or phased out. Or, roles change radically requiring complete reeducation and training, leaving behind those who refuse to or are unable to acquire the requisite skills. Or, that adoption of technologies enables a central corporate headquarters to conduct functions that now can be done in a standardized manner in one place, rather than at the local or regional level.
Not only are healthcare entities growing larger, but as they snowball, they are becoming more multifaceted:
Hospitals + Group practices + Outpatient clinics + Pharmacy + Retail + ACO + Insurance company
This unfolding area—the makeup of the mega-entities that provide healthcare for us all—will be the most influential factor on the future of the credentialing and enrollment professions. Especially integrated payer-provider systems. Some payers are acquiring hospitals and health systems, while some providers/health systems are creating their own insurance models.
Systems merge and purchase hospitals, picking up physician groups, each with disparate systems, and face the challenges inherent in integration. They all must enroll newly acquired providers into new insurance panels…unless the mergers consist of one partner that IS both insurer and provider. And that will create whole new opportunities.
None of us knows what to expect from the effects of the transformed healthcare landscape on credentialing and enrollment, but change is inevitable. What’s your take?