Curt Schroder, Regional Executive of Delaware Valley Healthcare Council of HAP
What does the future hold for traditional Medicaid? Some believe that, in the future, traditional Medicaid and commercial insurance will converge so that patients who move from Medicaid to commercial insurance will see no disruption in coverage, service, or the provider networks from which they receive medical treatment. While full convergence may still be a long way off, there are strategies that policy makers can begin to implement now on the pathway to a healthy Pennsylvania.
First, it is important to minimize coverage gaps. Pennsylvania should opt to continue Medicaid eligibility until the end of each month to allow beneficiaries to maintain coverage until they are covered under a commercial health plan (known as a qualified health plan) at the beginning of the following month. This provides individuals experiencing an increase in income with a smooth transition to commercial insurance enrollment at the end of their Medicaid coverage period.
Another strategy is to ensure continuity of care and of providers for traditional Medicaid recipients. For example, Pennsylvania could require insurers that offer both qualified health plans and traditional Medicaid to use the same provider networks in each. It could also require insurers to honor the current treatment plans of patients.
Drew A. Harris, DPM, MPH, Director of Health Policy Program at the Jefferson School of Population Health
Not everyone is cheering when more people have health care coverage. Some pundits are making dire predictions of long waits and overworked doctors when people newly insured under the Affordable Care Act (“Obamacare") seek care for long-ignored ailments.
Opponents of the ACA have even argued that we should continue to deny coverage to the uninsured because it will encumber the care of those fortunate enough to have insurance. This is like saying we should close food banks and cut food stamps for hungry people because the increased demand means less food for everyone else.
Despite these concerns, things may not be as bad as predicted. In the short term, waits for care may increase but in the mid to long term, I believe the system will adjust. Here are a dozen reasons why:
Jeffrey Brenner, MD, Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
For nearly 15 years we’ve had the secret to delivering better care at lower cost in America. The information has sat, hidden away in the medical literature, and barely mentioned among physicians. It’s a remarkable story of bias. The neglect of this information by the medical community tells you a lot about our failings as a profession and the poor training we receive. It’s also a powerful commentary on the values of our society and the biases built into our society’s view of health and healthcare.
In the 1990’s, a physician at Kaiser Permanente in California, Dr. Vincent Felitti, conducted a mail survey with 17,000 middle class patients. He asked them questions about traumatic events that might have happened to them as children. Incredibly, over 70% of people receiving the survey responded, and they gave permission to connect their survey answers to their medical records.
The survey asked questions about things like death of parent, physical abuse, sexual abuse, and substance abuse by a parent. Nearly 50% had at least one Adverse Childhood Event (ACE) and he coined the term “ACE score” for the point score created for the survey.
Tine Hansen-Turton, Chief Strategy Officer of Public Health Management Corporation
Where can you find the accessible, affordable, quality healthcare that the Affordable Care Act promises to provide? One of the best places, and one you may have overlooked, is a local retail-based convenient care clinic. There are over 1,600 clinics in 39 states today. Their growth is expected to accelerate as consumers who are newly insured under the law confront an increasing shortage of primary care physicians.
The growth of these convenient care clinics is also promoted by an ongoing shift in the way providers are paid. Reimbursement is moving from fee-for-service to payments based on value. The success of the new approach will depend in part on patients' ability to find high-quality, low-cost care, the kind that convenient care clinics are uniquely positioned to provide.
As part of the growth trend, an increasing number of large healthcare systems are partnering with convenient care clinics, and in some cases opening their own clinics. This allows them to deliver the most cost-effective care and to help find a regular primary care provider for the roughly 40 percent of convenient care patients who say they don't have one.
Paula L. Stillman, MD, MBA, Healthcare consultant with special expertise in population health and disease management
How often have we witnessed an adorable, inquisitive and charming toddler and wondered what does the future hold? What happens to that child in adolescence? Why do some of these children fail in school, choose unhealthy lifestyle options, have children at an early age and contribute to the cycle of poverty? I often wish that I could bring these adorable children into my home and use my resources to help them succeed.
As a former pediatrician, I was always interested in treating the acute and chronic manifestations of illness. If we could just get children immunized, get vision and hearing checked, and do preschool exams, we could contribute to the development of healthy responsible adults.
I have since changed careers and am now more interested in population health at the macro level. I realize that social and educational issues are at least as important as health care in determining the future of young children.
Obamacare, Medicare and Medicaid policy: working together to make our hospitals economically fragile
Howard J. Peterson, MHA, Managing Partner of TRG Healthcare, a national healthcare consulting firm
The economic condition of U.S. hospitals is more tenuous than private sector businesses. Citi Healthcare Investment Banking Group reports that hospital operating margins are 2 to 3.8%. These margins are very low when compared to target profits for commercial enterprises.
Three factors will further compromise hospital financial health under Obamacare: downward pressure on payments, disproportionate growth of the Medicaid population and the impact of high deductible plans sold on the insurance exchanges.
Generally, hospitals will experience a decline in their payments for services. However, their costs will continue to rise regardless of payment levels, reducing hospital profitability as they grow.
Krystyna Dereszowska, A third-year law student concentrating in health at Drexel
Over the past month, the media has been following the untimely deaths of Jahi McMath and Marlise Munoz—two bodies kept on ventilator support despite brain death diagnoses. Much of the discussion surrounding these high-profile cases perpetuates the misconception that brain death is not as final as cardiac death; that somehow these women can recover. Unfortunately, these tragedies highlight the importance of separating specialists from charlatans.
On December 9, 2013, thirteen year old Jahi underwent an elective procedure to treat her sleep apnea. Complications caused her to be placed on a ventilator, and despite several determinations of brain death, her family obtained a court order that prevented the hospital from withdrawing support. Earlier this week, her body was released to the county coroner who then released it to her family to take to an undisclosed location. Despite a death certificate, she continues to be kept on a ventilator.
Marlise collapsed in her kitchen on November 26th due to a pulmonary embolism. Although she has been declared brain dead and her family wants support withdrawn, the hospital has kept her on a ventilator because at the time of admission she was 14 weeks pregnant. Texas law prohibits a hospital from withdrawing support from a pregnant patient, although a court has yet to decide whether the law was meant to apply to a patient who is deceased.
Robert B. Doherty, Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
On Tuesday of this week, as I was starting on my way to Reading Hospital to give a Grand Rounds presentation to physicians and nurses on the Affordable Care Act, I was involved in an auto accident that totaled my car. Due to driver error (mine), I inexplicably side-swiped another vehicle that was in my blind spot, left the road, and hit a tree at 30 MPH. All of this in broad daylight, modest traffic, and no roadway ice.
Fortunately, I am generally okay--some bruises and a fractured sternum, and associated aches and pains being managed with painkillers, but that's it. I have full collision damage and personal injury coverage from my car insurance company, and excellent health insurance paid for by my employer, the American College of Physicians. I will end up paying only a $500 collision deductible when all is said and done.
For obvious reasons, I had to reschedule my presentation to the good doctors and nurses at Reading. But this accident taught me some valuable lessons that I might mention next time I give a talk about Obamacare.