Curt Schroder, Regional Executive of Delaware Valley Healthcare Council of HAP
Among its many worthy goals, the Affordable Care Act (AKA Obamacare) aims to nudge the U.S. health care system from sick care to well care. By increasing the focus on routine checkups, preventive care, and better patient outcomes, Americans will be healthier. They will need less intensive, expensive health care. Health goes up, hospitalizations—and costs—go down.
In Philadelphia and its suburbs, hospital stays and days have dropped steadily—down about 12 percent*—since the enactment of the Affordable Care Act in March 2010. On the measure of less hospital care, could Obamacare be working?
As the leader of the region’s hospital association, I can assure you that hospital leaders are indeed working to achieve the goals of the Affordable Care Act. They are rethinking how their organizations deliver health care. They are investing in new ways to keep patients healthier, to keep them out of the hospital. If hospitals were airlines, it would be like changing the wings on the airplane while in flight.
Tine Hansen-Turton, Chief Strategy Officer of Public Health Management Corporation
There is a lot of confusion and misinformation about how the world of health care is changing around us. Today’s concern might be a website that does not work for enrollment, but tomorrow’s real issue is the lack of an adequate primary care workforce to meet the needs of the newly insured. Obama’s Affordable Care Act takes one major step to address it. The law makes a significant investment in nursing workforce development, specifically in nurse practitioners.
However, there is more that can be done. Educating and training more nurses is not enough. In order to build primary care capacity, we must invest in models of care that give nurses the opportunity to gain hands on experience delivering community-based care to the underserved.
The Association of American Medical Colleges projects the shortage of primary care physicians will grow to 65,800 by 2025. With over 30 million Americans poised to receive health coverage through the new law, the nation desperately needs to increase the number of primary care providers. To meet this need, the Institute of Medicine’s report on the future of nursing calls upon advanced practice nurses (such as nurse practitioners, nurse midwives, clinical nurse specialists) to fulfill and expand their potential as primary care providers across practice settings.
Laval Miller-Wilson and Antoinette Kraus
The tens of thousands of Pennsylvanians who recently received cancellation notices from their health insurers are understandably worried. Few know that feeling better than 41,000 Pennsylvanians who saw their adultBasic coverage cancelled two years ago. The key difference: most of those who lost adultBasic weren’t able to find other coverage as insurers could still deny coverage to people with pre-existing conditions, charge high rates for skimpy coverage, and restrict care by placing lifetime and annual limits on coverage.
Those who lost adultBasic didn’t have access to tax credits to reduce their monthly premiums, or cost-sharing help to cut their out-of-pocket costs, as most of those receiving cancellation notices will, by getting a plan in the Health Insurance Marketplace under the Affordable Care Act (ACA).
The two situations are not directly comparable, but there are some important lessons learned from this experience:
Paula L. Stillman, MD, MBA, VP Health Care Services & Dir. of Institute for Population Health at Temple University Health System
Our nation continues to struggle with providing health care to the people who are on the lower end of the socioeconomic ladder. Not being able to afford health care and not having health care coverage is a disaster, especially when you have a chronic condition.
My son, an internist, published an article, “Dead Man Walking,” in this week’s New England Journal of Medicine (Stillman & Tailor, 2014) describing several patients in his practice who had inadequate health care coverage. This problem is widespread and exists, right here, in North Philadelphia.
To address this problem in North Philadelphia, Temple University Health System, has trained and employed a number of Community Health Workers (CHWs) to help this defenseless population. The CHWs are highly motivated individuals from our community who undergo an intensive five week training program and then are asked to serve as liaisons between our highest cost, highest risk most vulnerable patients and their health care providers. We assign the CHWs to patients with chronic illness who do not have a primary care physician, are frequently admitted to the hospital and use the emergency department instead of visiting a physician’s office for non-acute health care needs.
David Nash, MD, MBA
A delivery truck carrying your company’s goods is detoured more than 100 miles around a closed bridge, causing it to be late in getting key parts to a supplier, not to mention wasting gasoline and incurring extra labor costs. The decaying bridge could not be repaired because the annual budget for the Commonwealth is out of control due to the ballooning cost of healthcare.
This scenario clearly got the attention of an assembled group of leading corporate CEOs during a recent closed-door meeting. Business needs health reform because healthcare costs are accelerating like a runaway train, and a good portion of those costs make no sense and do not contribute to improving the health and well-being of employees. Let me deconstruct this challenge by first asking several basic questions: What do we spend for care and why?, and What do we get for the money we spend? Then I’ll propose a plan for engagement.
Healthcare costs are the key driver of the federal deficit, especially costs associated with entitlement programs like Medicare and Medicaid. In fact, the percentage of the GDP dedicated to healthcare, perilously close to 18%, is nearly 4 times what the United States spends for our military worldwide. If the entire healthcare industry were to somehow secede from the Union, it would represent the sixth largest GDP in the world! The magnitude of this spending prevents investments in public education, communication, transportation, and places our entire infrastructure at risk.
Robert B. Doherty, Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
Much of the news lately about the Affordable Care Act, also called Obamacare, has been about the troubled rollout of the web marketplace enrollment and the cancellation notices going out to a segment of the 5% of Americans who get coverage from the individual health insurance market. (Read this for an accurate explanation of what is going on with the cancellations. And this about President Obama’s announcement of a policy change that may allow some people to keep their cancelled policies for at least another year.) But there is another Obamacare story that has gotten much less attention: enrollment in Medicaid, which is being expanded in many states, is going like gangbusters.
Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only “a trickle of sign-ups for private insurance.” Oregon, for instance, cut its uninsured “without signing up a single person for private health insurance.”
This is a potentially watershed development, because Medicaid is Obamacare’s only true public option: a program jointly administered and funded by federal and state governments. (Although many liberals had sought to have another public option added to compete directly with the private plans offered in the state marketplaces, that version of a public option never made it into the final law). But Medicaid, which even before the ACA was the largest insurance program in the United States with 62 million enrollees, is central to Obamacare’s goal of providing health insurance to nearly all Americans.
We are one month into the official roll out of the Affordable Care Act (ACA). It is quickly becoming clear that the ACA has explicit policies, and the Obama Administration has unspoken intentions that will produce unforeseen consequences for our healthcare system and could have broad societal implications.
Just last week we were alerted to widespread health insurance policy cancellations despite repeated assurances by President Obama that we “could keep our health plans if we liked our health plan ‘period’.” We now know that there was an explicit policy to eliminate a broad number of individual health policies, three million so far and projected to be as many as 15 million. The likelihood of these cancellations was known as early as 2009. Regardless, throughout the President’s second term candidacy the ACA was sold on the basis that if you liked your plan you could keep your plan.
Consider this development a bellwether for more to come. Another arena of likely impact is critical access hospitals (CAH’s), those under 25 beds and located in rural areas. The Department of Health and Human Services has decided to reassess the status of these hospitals with a plan to decertify many of our CAH’s for failing to fulfill certain national location requirements (i.e., they must be 35 miles from the next hospital). Nearly 75% of these hospitals, including many in Pennsylvania, could be affected, losing their enhanced Medicare payments and becoming economically unviable.
Neil Goldfarb, President & CEO of the Greater Philadelphia Business Coalition on Health
We’re currently at the height of “open enrollment” season – the annual period during which most employers offering health benefits to their employees roll out information on changes to the benefits plan and assist employees in making their benefit selections for the coming year. Employees can expect to see new programs, incentives, and opportunities offered by their employers with regard to wellness program participation and achievement of wellness goals, as a result of the ACA. Unfortunately, when it comes to the employer wellness program rules issued this summer by the US Departments of Health and Human Services, Labor, and Treasury, ACA might well stand for the Ambiguity and Confusion Act.
According to the official Fact Sheet on the Affordable Care Act and Wellness Programs (http://www.dol.gov/ebsa/newsroom/fswellnessprogram.html), the “Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces.” What’s not said is that the Act places employers at increased risk of litigation and expense, stifles innovation, and vitiates employers’ ability to address the population health crisis of unhealthy lifestyles.
Among key features of the rules is the distinction between “participatory” and “health-contingent” programs and incentives. Participatory programs either do not offer a financial incentive, or link the incentive solely to participation in general aspects of the program, such as completing a health risk appraisal or attending a wellness seminar. Health-contingent programs and incentives involve participation in a program addressing a specific health factor (e.g. weight management program) or achieving a particular outcome (e.g. losing weight or achieving normal body mass index). There remains some ambiguity as to when a participatory program crosses the line and becomes health-contingent, even though it remains focused on participation rather than an outcome.