Health Reform Moves Forward
Well, now that the Supreme Court ruling on health care reform is out … it will take us all some time to determine what it really means. What we do know is that the health care reform law will stand in its entirety, with some changes related to Medicaid penalties to states as they implement some of the expanded eligibility requirements. Many of us will spend at least some of the next week reading the Supreme Court’s opinion and thinking through the implications.
The health care reform debate began as a way to try to meet the Triple Aim, a framework developed by the Institute for Healthcare Improvement to improve care, improve patient experience, and reduce costs. Like many both working in health care and experiencing health care as a patient, I applaud these goals, but many of the provisions of the law were untested ideas.
What has concerned me from the passage of the law is that we have not translated the provisions of the law into the implications to operations for providers, consumers, and payers. Under current payment policy Medicare and Medicaid typically pay less than direct costs for services provided — private and employer sponsored insurance make up the difference. With greater numbers of employees transitioning to the health care exchanges and others to Medicaid, the funding for health care services provided today could decline substantially.
Effect of reduced costs
We all know the goal of health care reform is to reduce costs, but most of us did not anticipate the large cut in funding that could be coming … even with some increased volumes. This level of change will take a significant toll on the organizations and the individuals who work in the field. The impact will not just be on our hospitals, doctors, and nurses, but on all segments of the health care field, including, suppliers, manufacturers, and pharmaceutical and medical device companies. If we believe we should spend substantially less on health care in the United States, then we have to adjust to the fact that there will be winners and losers in this process. This seems like a daunting challenge, but around the country I continue to be amazed at the innovations being developed and implemented by the early adopters.
I hope that over the next few months, as we continue to sort out the implications of the Supreme Court decision, that all providers, health care manufacturers, and device companies will take a fresh look at the Accountable Care Act. There still may be changes in some of the health care reform law, but the Supreme Court decision simply means that many more of us must step up and define how our organizations are going to move forward.
We may not achieve a 50 percent reduction in costs of care, but we will find ways to make health care more affordable. We will continue to improve quality and address patient-centered care through innovative solutions. I am, and continue to be, optimistic that health care in the United States is the best and that with continued focus, greater collaboration across the continuum, and a slight push, we will be able to meet the challenges of the Triple Aim.