As the new administration and the GOP propose various iterations of ACA replacement ideas and plans, I’ve succumbed to the temptation to evaluate their potential impact on patients, providers, payers, HealthTeamWorks, and the healthcare industry as a whole. Keeping pace has been no small feat – as congressional leaders consider an “invisible risk sharing” modification to the previously proposed American Health Care Act (AHCA) – it remains unclear what the first wave of change will entail.
Nearly all congressional discussions, proposals and highly publicized disagreements on replacing or “fixing” problems with the ACA have focused on insurance coverage and benefits, including patients’ access to care via health insurance. While there has been no disagreement that the healthcare delivery system needs to be redesigned, it is unlikely that this will be accomplished through executive orders, a federal budget reconciliation process or even new legislation. Where actual change will occur is at the grassroots level. Sustainable reform is already well underway through the collaborative efforts of patients, providers, payers (both CMS and commercial), HIT companies, and local communities, with support from organizations like HealthTeamWorks and many others. Delivery system reform doesn’t focus on insurance coverage. It’s focused on improving how providers care for patients, manage population health, and decrease patients’ duplicative and otherwise avoidable utilization of healthcare services.
A widely accepted framework for health system reform is detailed in “Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative” (March 21, 2017). In the paper, the authors list four policy priorities: (1) continuing and accelerating a shift of payment from volume to outcomes and value, especially to support stronger integration of health and social services; (2) empowering people with better health literacy, telehealth, data access, and attention to the health-related goals of individuals; (3) activating communities to strengthen public health and social care supports, especially for people with the greatest illness burdens; and (4) achieving much better integration of information systems with “end-to-end interoperability” and patient ownership of their own data.
In addition, the paper identifies four infrastructure priorities: (1) developing and deploying more meaningful and efficient measures of performance; (2) modernizing the skills of the healthcare work force to succeed in a resigned system; (3) improving investments and support for continuous learning from the processes of care, rather than over-relying on randomized clinical trials; and (4) expanding investments in relevant scientific research, including stronger public-private partnerships. These priorities largely influence or guide the work of HealthTeamWorks, as we engage with 4,500 medical practices and hundreds of integrated delivery networks in 16 regions across the country.
So, while we’re paying attention to what’s going on in Congress, we are not obsessed with evaluating the potential impact of each and every congressional consideration for ACA replacement as we know that they change on a weekly basis these days. However, we do remain obsessively focused on collaborative efforts to improve performance in medical practice and integrated delivery networks and continue to work to redesign the health and healthcare delivery systems in communities and regions in Colorado and throughout the United States.
Dzau, V. J., McClellan, M., & Burke, S. (2017, March 21). Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative. Retrieved April 12, 2017, from https://nam.edu/wp-content/uploads/2017/03/Vital-Directions-for-Health-Health-Care-Priorities-from-a-National-Academy-of-Medicine-Initiative.pdf