The No Surprises Act intends to prevent patients from getting burned with huge, unexpected bills for medical services. It is a needed law – medical bills are the #1 cause of bankruptcy in the U.S. And it’s certainly noble in its intentions.

However, the healthcare machine works in unexpected and unintuitive ways. It has a way of moving surprises when we try to eliminate them. In this case we may exchange surprise bills for new health access and health equity issues. And we will certainly create new surprises for the business. The law requires new and overhauled workflows, enhanced capabilities and technologies, and a solution to that pesky Provider Directory problem.

Oh… did I mention it goes into effect on January 1, 2022?

Giddy up!

Is it the No Surpises Act, or the New Surprises Act?

On this episode, I talk with Gail Zahtz, CEO at PropHealth, as part of our ongoing Value-based Payment in 2022 series about The No Surprises Act.

We’ll explore:

  • What is the No Surprises Act?
  • Who is affected? (Spoiler: The entire healthcare industry… especially providers… and around 221 million Americans)
  • What is required to happen?
  • What workflows are needed to support this?
  • What unintended consequences could play out?
  • Why and how providers will be left holding the bag.
  • What providers, and the entire industry in general, needs to do right now.
  • How this fits into our conversation on VBP in 2022.

This may be about as negative as I’ve ever been on this show. I love the intent of the No Surprises Act, but I’m fearful for what’s going to happen because of it. If you can explain this in a way that makes it ok, please reach out.

Gail Zahtz

Zahtz has been founding and running mission-driven organizations from the get-go.

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Today, Gail Zahtz is the CEO of PropHealth, a value-based administrator that creates and manages healthcare collaboratives to drive clinical and financial success. Their expertise and services focus on contracting, operations and growth for clinically integrated networks, risk bearing entities, and those that fund and deliver healthcare innovation. 

Her healthcare career has been guided by these truths: 1) Sustainable change will only happen when every stakeholder gets value, 2) It is good business to “do good” 3) Mission matters, 4) Business can only sustain service with profit (it’s not a necessary evil, it fuels growth), 5) It’s all about experience, 6) The true north is the patient journey – always. 

Being mission-driven always has and continues to shape her career. Right out of college, Gail helped to shape health policy in Washington DC. In her first start-up, she addressed work-related health issues for employees through a cause-related marketing agency. Independently she created an award-winning program to reduce the stigma of mental illness by creating a novel public-private partnership.

On many occasions, Gail has spoken to small and large audiences and through social media platforms. She advised the industry on designing for health outcomes and won numerous awards including – Top 100 in Health Info Technology, Top 100 International Influencers in Health Online, Healthcare IT News’ #HIT100, Recipient Walking Gallery of Healthcare, and Top 50 Most Influential Health Leaders. Her public health education campaigns have also been nationally recognized including being awarded the most influential public education campaign by the National Mental Health Association.

As a survivor of late-stage cancer and of domestic violence, she is particularly inspired when sharing her stories of how to survive and thrive despite the most challenging of circumstances to show a way forward to young women everywhere.

To connect with Gail, reach out on Linked In @ https://www.linkedin.com/in/gailzahtz/

Or, on Twitter: @GailZahtz


PropHealth

PropHealth is a value-based administrator that creates and manages healthcare collaboratives to drive clinical and financial success. Our expertise and services focus on contracting, operations, and growth for clinically integrated networks, risk-bearing entities, and those that fund and deliver healthcare innovation.

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Links and Resources


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Music by StudioEtar