Role and Opportunities for Health Education Professionals

The Patient Protection and Affordable Care Act has introduced both new models of service delivery and new models of payment or reimbursement to health providers, all in an effort to achieve the Triple Aim: improving population health and health outcomes while lower costs.  Presently, through the use of innovation grants, 1115 Medicaid Waivers, and a general willingness to allow experimental models of reimbursement, there are few providers or entities using the same model.   This session will cover the basic economic considerations that are faced by all ACO, PCMH, or other managed care systems and the compromises that must be reached for that system of care to achieve cost savings and thus profitability.  Often these considerations are at odds with one another and are frequently driven by private insurance companies.  Health Education Specialists must understand where they could fit in to these financial models given the lack of reimbursement or, where reimbursement exists, very low rates not covering the true cost of hiring.  At least for the time being it will be incumbent on the Health Education Specialist to advocate that our core competencies are valuable enough to stand on their own and still be attractive to these new payment methods especially within a medical setting.