Healthcare reform is upon us – what will be affected?
By Jay I. Pomerantz, MD – Executive Medical Director for Health Integrated

The healthcare reform bill passed and was signed into law in March.  As it comes to fruition over the next decade, there will be many different changes.  I have spent much of the last 6 – 8 months talking to various aspects of healthcare reform, all of which have the potential to dramatically affect the manner in which care is doled out, to whom and the subsequent outcomes achieved.  Let’s talk about this further.

I wanted to note though, change is afoot, and it has not taken the legalities and formality of the recent bill to catalyze reform within our healthcare system.  It has been reforming in a variety of ways over the last several years.  Many of the changes have been initiated by progressive health plans which are always seeking new ‘out-of-the-box’ approaches to both improve the overall health services and outcomes provided, while simultaneously reducing the cost footprint.  Programs like the patient-centered medical home (PCMH) are one such program.  At last count, there are over 27 multi-stakeholder pilots underway in 20 states.  Other programs like Accountable Care Organizations (ACOs), Utilization Management (UM), Population Health Management (PHM) and others continue to contribute to the evolution of our healthcare system.  I believe that the market will continue to drive better outcomes and efficiencies in tandem with any legislative changes that are implemented.  Collectively, this will help the system equilibrate to meet the changing landscape.

If I were to summarize the changes the recent legislation is bringing to the market, it could be done as follows. In general:

• Regarding insurance – eventually it will be guaranteed and the ‘pre-existing’ clause eliminated
• Early retirees will have access to re-insurance programs
• If initial Medicare drug benefits run out, a $250 rebate will be issued
• Additional pilots for PCMH and similar programs are to be funded by HHS

Beginning next month:

• Lifetime limits on insurance will be prohibited and cannot be cancelled
• Children with pre-existing cannot be denied, and all children can be carried until age 26 on parents plan
• Preventive services will be covered with no co-pay in private plans
• Insurance cannot be cancelled due to paperwork errors
• Unreasonable rate hikes will be investigated

This year:

• Help provide to qualified seniors for medications
• Members with uninsurable health problems can utilize a special federal program
• More oversight on rate increases and tax breaks for small businesses
• Financial incentives for students pursuing primary care specialty in med school

For 2011:

• 80% of premiums to be spent on healthcare
• No co-pay for preventive service in Medicare plans
• 50% discount for seniors who reach the Medicare ‘donut hole’ for drugs
• Free preventive care for seniors in Medicare
• States can offer home and community services for the disabled through Medicare

For 2014:

• Insurance rules change dramatically – exchanges created, full acceptance for all
• Family subsidies for qualified parties
• Employer mandates for non-insurance
• Everyone required to have insurance

Beyond:

• Reduced Medicare payments to certain hospitals for hospital-acquired conditions
• Insurance benefits will be taxed
• Insurance for everyone will be available

For health plans, the amount of change on the horizon is staggering.  The number of members covered and services provided will both increase.  The bottom line is that insurance cost to the member will be affordable, accessible and everyone has to have it.  This in and of itself though, won’t fix healthcare.  It will however, require changes in how healthcare is administered in order to reduce the associated costs while minimally providing equivalent outcomes.  Other systemic aspects like PCMH, ACO, incentive reimbursement reform, implementing better utilization management and other similar paradigm-shifting programs will drive positive change to both outcomes and cost.  Longer-term incentives for a continued primary care focus in current health planning and in medical schools will get the emphasis where needed for more preventive and wellness-based medicine.  EMRs will drive data collection and the subsequent dissemination of this information will allow physicians to practice optimal evidence-based medicine as well.  There is so much we can do, but I feel we are well on our way.

What do you think?

We are fortunate to have Julie Barnes, Director of Health Policy at the Bipartisan Policy Center, keynote at the upcoming Health Integrated Fall Executive Leadership Series Event in Chicago on September 22 – 23.  This post touches on topics related to her presentation.  The detailed session at the ELS will delve in further on ‘The Reform World We Live In’, with a moderated panel on the healthcare landscape.  This is a very relevant session given the current state of reform.  I encourage your participation.  As well, I look forward to meeting you there.  Visit our website for more details. 

Thanks for reading.  Feel free to comment directly or send me your thoughts on this post as well as other topics that would interest you.  You can reach me directly at healthexecforum@healthintegrated.com.  

Best Regards,

Jay I. Pomerantz, MD

 

Other support data and information regarding healthcare reform:

H.R.3200: http://www.opencongress.org/bill/111-h3200/show#
Kaiser: http://www.kff.org/healthreform/8060.cfm
Whitehouse: http://www.healthreform.gov/

---

---

This entry was posted on Thursday, August 26th, 2010 at 6:52 am and is filed under Healthcare Reform. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.