The First 100 Days: Health Care
A panel discussion presented by
"We're going to repeal it and replace it. " We haven't heard a politician repeat the same line about health care over and over since .."If you like the plan you have, you can keep it." If only health care in this country were so easy. With the swearing in of
Can the ACA just go away?
It's a simple question with complicated answers. Here are the views of our experts:
Brach Eichler
The elephant in the room is the federal government. With the Affordable Care Act, many people focus primarily on dte insurance mandate, bul there are enormous and varied innovations that have been adopted and developed under the Affordable Care Act. (Accountable care organizations), (bundled payment care improvement) plans. It's very bard for me to believe that those are going to go away, I think we need to focus on how that develops and whether ihat continues under the aci.
If we were thinking about cherrypicking any aspect, it's the aspect of population health and fee-for-value. There's no real way to manage those costs, because you need to try to move to a bundle payment or a papulation payment based on quality to improve the quality that's provided to the patient as well as the costreduction that could be leveraged. T think dial's a bipartisan issue. I don't think it's going away,
My organization depends on change to innovate. What are the problems that need to be fixed and how do we fix that with people and processes. Some of that comes from federal funding and others from things that we develop or solve ourselves for die marketplace. We have a client that's going almost entirely to a bundle payment structure for their entire health system; that's a radical change in terms of how you diink about putting everydiing together close to diat single mindset that you were talking about in terms of one way to pay and one way to collect. So, I think we're in good shape that way, with what's coming from a healdi care perspective, but diere's still a lot of uncertainty.
You see die difficulty' in what's going on. The
What strikes me is die structural change in the system. 1 was in
TIM H0DGE5
CareOne
I think what's important to keep in mind with all these ACA initiatives that affect the provider community, such as bundled payments and accountable care organizations, is that it seems to me that everything is based on historical outcomes and historical spend. So diere comes an inflexion point, and I don't think we're diere yet, when you reach maximum efficiency. And then the quesdon becomes, at what point when you've realized as much savings as you can versus historical trends, when do you start rationing care? When does it stan impacting bedside care?
We have to start asking those questions. We are the most successful society in the universe, my feeling is we should have the best health care. We want it to be the most efficient, but at some point we come to the point that we can't save anymore or we're going to impact clinical outcomes. 1 think, as it relates to the first 100 days, that should be and I think it will be an important consideration in where we are going the next five or 10 years.
It's unrealistic to think there's going to be a repeal or a big change. From where 1 stand, going back to what was before the ACA is really not an option. That's not a realistic option. The economic fundamentals over die cost of health care both in
If you really want to save the system, competition is a big, big thing. I'm a big believer of open markets and competition. But there has to be rules and there has to be transparency. And you have to compete on the right metrics. Today, we're competing on all the wrong metrics, we're compering on the necessity to have a very expensive computerized system in the office. We're competing on the accuracy of your coding as opposed to die actual delivery of care and die conversation you are having with the individual. We don't measure that relationship. Those are the things we have to change. If we don't change the metrics, and we keep measuring the wrong things and valuing the wrong things, we're going to get the wrong outcomes. That's the crux of this transition and what's going on.
Someone in die new administradon has got to step up and start to define what we're doing moving Forward, and not everybody is going to be happy. Trust me, most of my colleagues are going to be furious, because they've invested a lot, building diese large systems. The payers will be furious. You know you have the right answer when you have die right degree of pushback from all die right sectors. And if you don't, it's not balanced die right way, you've either gone too much to the provider side, too much to the payer side or too much to the consumer side. Everybody's got to have skin in the game and if you feel that reverberation from all three sectors, then you know you're on the right path. We're not diere yet.
Triton Benefits & HR Solutions
One of the things we've seen, the president is looking to cut costs,
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The emergence of private equity
The ACA wasn't created with private equity in mind. In fact, far from it. But with its implementation, more private equity money is coming into the system, trying to figure out a way to ... well, let's face it, make money. Repeal? Replace? Our panelists seemed to feel the money people will be involved no matter what the system. *And that the health of consumers, the goal of the ACA, is not a concern. Here's the take of some of our panelists;
Triton Benefits & HR Solutions
There's a lot of money on
We're now seeing private equity moving into the physician market. Private equity, which is incredibly profit-driven, is buying up multiple physician groups, even across stale lines. So, now they're looking to build up volume, looking to build up ways to build up innovation, drive cost down, deal with die bundled care. Anytime private equity moves into a market, you know there is excess cash on die table, because that's where they're looking to get their return, either by driving down costs or increasing yields.
They are aggregating physician groups in individual specialties as well as cross-specialties, and they are mixing in hospitals. They're building up in a way to extract whatever excess profit there is in the system, either by reducing costs or finding ways to more efficiently spend the money that's in the system.
The opportunity today does not exist on the innovation and die cost side. There is no quality improvement, diere is no cost improvement (through mergers). What there is, is leverage, to negotiate better rates in a fee-for-service world. If I can get better rates, I can get better return. If I can leverage physician groups, or hospital systems or any segment of die market, 1 can get belter rates.
Greenwald: In the private equity world, that is efficiency.
Maron: But to the people who are seeking those services, it's not. Here's what is it doing: It is either inflating or artificially suspending high prices to begin with. And you should be outraged about it; it's the diing people don't talk about. If you want to go to value, it's an equation that equals cost plus quality. Quality is now in its infancy, starting to become transparent. Seven hospitals received top-performing quality awards. Just seven. There's real issue there. Where is the cost side of the equation being made public so a consumer can understand die true value proposidon?
The demise of the small practice
The Affordable Care Act, at its core, was meant to give health insurance coverage - or, better put, health care - to the millions who were uninsured or in danger of going bankrupt to pay for service. Has it worked? We'll let you decide. But, this point is clear: The ACA, with its endless lists of rules and regulations, has played a part in the surge of consolidation of physician practices in the industry. We asked our panelists if we are going to continue to see more consolidation in the industry if there are not major changes to the ACA. You may be surprised by some of the answers.
Brach Eichler
On the physician side, you are going to continue to see consolidation. A big motivation for physicians going to a larger group is to get rid of the administrative burden of dealing with insurance companies. If you talk to doctors, they talk about how many hours they deal with insurance companies and the paperwork they have to do. That is a big driver, a hidden driver of consolidation on the physician side.
So, on the physician side, you'll see a tremendous consolidation, which feeds into the innovation, because it's very difficult to do the innovation with small physician practices. There are large physician groups that continue to get bigger, such as
CareOne
It is very hard for the solo practitioner to meet the demands of investing in electronic health records, investing in disease management programs and administrative costs, etc. My view is over the next five years you're going to see the most significant change in consolidation in that physician market.
Physicians weren't good at setting up infrastructure to begin with, so now that they've gotten rid of it, to ask them to disaggregate and go back into these small two- to three-person physician practices and start that all up again by hiring staff and billing systems and doing all that isn't possible. They're just not going to do it. You might see sort of a sea change.
You've got the current generation that's marching through the desert, but nowyou've got tlte new generation of doctors that mighi come along in lOor 15 years that say, '1 don't want to be part of that big behemoth, I might hang out my own shingle, because now I've got technology from
You'll see big groups for 20 years and diey'U stan to retire and nobody is going to come along and buy their shares or take over dieir role as an employee. But you'll have a new group of employees that will say, I want to do things my way, I want to practice die way I want to practice. I don't mind giving out my quality repons because I üiínk I'm terrific and 1 want the public to come to me because I'm good, not because I'm convenient.
One more thing
Our panelists had a lot to say. And, we promise, we'll have more of it online. But here's one closing thought on the state of health care today, as in the era of the Affordable Care Act,
Brach Eichler
Let me throw in a point of optimism. How do we explain die fact that it's harder and harder to go into medical school? There are still young people who want to go into medicine. They tend to want to work less, spend more time with dieir families. But they care about their patients just as much as anyone else; it's just part of the restructuring that's going on.
The government's data is so old, it's 12 months old or ÍB months old, you realty can't do a baseline on how things are going in real time. All the other companies have access to claims within 30 days, so you, as a consumer, can see some comparison in real time.
CareOne
In our business, we have Medicare Compare. Any consumer can go online and review the quality and outcome ratings of a home health care agency, a hospital, a hospice, a nursing home, etc. Recent studies have indicated that less than 1 percent of
What should happen with the Affordable Care Act? There are states, most of which are on die
Triton Benefits & HR Solutions
If you have good health, you get a different life insurance rate. If you have good credit versus bad credit, you get a better interest rate. Medical insurance is different. Ifyou eat a five-course meal or go to a gym, you get the same premium. So, no one is getting rewarded today for good health. By having this whole (health savings account) concept and rewarding yourself by taking care of yourself, that monetarily, should benefit dial individual.
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