The Supreme Court decision on the constitutionality of the Patient Protection & Affordable Care Act—or as its detractors call it, ObamaCare—was a victory for the President, judicial precedent and the estimated 32 to 50 million Americans who will soon have access to healthcare.
As Americans, we care about the health of our brothers and sisters. Today is a good day, but regardless as to which way the Supreme Court had ruled, the United States’ healthcare delivery system was going to continue down the path of change it has been trudging for the last several years.
Those involved in healthcare would have to be blind not to notice our system is broken. The United States spends the largest percentage of its gross domestic product of any nation on healthcare expenses, but the World Health Organization ranks its healthcare system at No. 37 when compared to other countries. By contrast, France spends the second largest percentage of its gross domestic product on healthcare, and its healthcare system ranks No. 1 in in the world.
I write about healthcare from the standpoint of medical professional liability, and in May, I attended the Physician Insurers Association of America’s Annual Medical Liability Conference in Washington, D.C. During his keynote speech, healthcare futurist Ian Morrison, PhD, emphasized how regardless of the Supreme Court’s ruling, the transformation of our healthcare delivery system would continue unabated.
“We are in the midst of a healthcare delivery transformation, which will be unaffected even if the Supreme Court—or the upcoming presidential election—overturns the Affordable Care Act,” Morrison said. “The momentum behind the transformation of the delivery system is immense. It’s very safe to say the train has left the station, and it’s very unlikely to ever go back to the way it was.
“The Affordable Care Act stimulated this conversation at the national level, but what is driving this transformation is a relentless pressure from purchasers of healthcare who are dissatisfied with both the quality and performance of American healthcare. We, as Americans, pay more for a system that underperforms in so many metrics.”
Earlier this year, I had the opportunity to interview Wayne Lipton, founder and CEO of Concierge Choice Physicians, a New York-based company that helps primary care physicians implement a hybrid model of concierge healthcare. He seemed mildly surprised that people feel the Affordable Care Act has been the driving factor behind the changes occurring in healthcare.
“Yes, healthcare delivery is changing, but it’s been changing as long as I’ve been in the industry,” Lipton remarked. “Future change is going to be built around a continued downward pressure on cost and establishing a greater universality to care.”
Many in the healthcare industry view the Affordable Care Act and its reliance on accountable care organizations to curb costs as another attempt at managed care, an idea that failed in the 1990s. So why are we returning to it now?
First, accountable care organizations are built around healthcare providers rather than healthcare insurers, and accountable care organizations payment approaches will include improvements in quality of care measurement that take into account the continuum of service delivery they are designed to provide.
Second, we now have the technology to do managed care right. HIPAA-compliant information technology, specifically electronic health records, will ultimately save the healthcare system billions of dollars by helping doctors reduce the number of redundant or inappropriate tests they order. Each new physician a patient visits will have access to the notes of the patient’s previous physicians or the one that referred the patient to them.
Back in March, when the Supreme Court was first hearing oral arguments on the constitutionality of the Affordable Care Act, I had a great conversation with Barry Couch, founder and chief executive of HealthSure, a company that works with hospital boards, physician groups and healthcare management teams to create competitive advantages, control costs as well as put together insurance packages to cover and reduce risks in the healthcare industry. A longtime hospital trustee and licensed risk manager, Couch remarked how regardless as to whether the Affordable Care Act is deemed constitutional, the healthcare reimbursement model moving forward would necessitate physicians participate in some form of managed, or integrated, care.
“Whether you are a physician or a hospital, if you are not participating in an integrated model, you simply will not have the patient flow needed to stay in business,” Couch explained. “The health insurance companies, Medicare, Medicaid are all going to contract with large integrated networks and bundle their payments for the defined population in an area. It will be a challenge for the independent, small hospital or independent practitioner not in some sort of direct ownership integration or quasi-collaborative-type of arrangement. There is going to have to be some contractual arrangement to be guaranteed a patient flow.”
It’s great news that the Supreme Court recognized the constitutionality of the Affordable Care Act today. Millions of previously uninsured Americans will now have access to healthcare, those with preexisting conditions will no longer be excluded and our healthcare system takes a proud step in the humane direction. That said, the United States’ healthcare delivery system is just continuing down the path of change it has been trudging for the last several years.