Policy & a Pint: Federal Health Care Reform and its Impact on CT
Sponsored and Hosted by Saint Francis Hospital & Medical Center
A HYPE Event Recap by Samantha Forbes
How did we fit a 2,000 page bill into the confines of a 2 hour panel discussion and Q&A? If you are talking about this event, I’d have to say extremely well! With our astute panel and capable moderator Steve Jewett (Director of Public Relations, ConnectiCare), many of the major highlights of the law were hit and some excellent questions answered quite succinctly. The issue is dauntingly broad, making careful formulation of the questions essential to quickly get to heart of the issues. For example, one of the main themes running throughout was the panelists’ takes on the strengths and/or the missed opportunities of this reform effort.
All the panelists seemed to agree unequivocally that this legislation is health insurance reform and not health care reform. They also agreed that coverage was the supreme goal here but clearly did not give much deference to the symbiotic issues of access or cost containment. For example, by 2014, 30 million more people will be insured, of which 15 million will be added to the Medicaid rolls, which will push the issue of access to services to its brink. Marty Gavin, President and CEO of Connecticut Children’s Medical Center, stated that 45% of children CCMC sees are private pay and the rest are Medicaid. He was echoed by the others when he said “Coverage doesn’t ensure access.” Audrey Honig Geragosian, Communications Director of the Connecticut State Medical Society, represented the voice of the small group physician practices and reported that the Society just completed a report on capacity among primary care physicians (PCPs) in CT which revealed that 28% of PCPs are not taking new patients. She went on to say that while there is money included in the legislation to encourage the growth of primary care practitioners, this resource is likely to be strained in that all 50 states generally bear this same burden.
The other 2 major thrusts of this legislation are 1) quality improvement of services and how services are delivered, and 2) reducing cost by shifting how we pay for services from the current fee-for-service method to the purchasing of outcomes. So, instead of paying practitioners for each test and visit they conduct, they would be paid a certain amount per patient and then be given an additional sum for achieving healthy outcomes. However, panelists agree that this shift in cost structure does nothing to control the actual cost of health care which, along with access seems to be the quintessential elephant in the room. If anything one panelist remarked it will drive up the cost of insurance premiums because practitioners will likely raise their fees to cope with the additional demands placed on them.
One of the ways that this reform effort attempts to induce quality improvement is the expectation or requirement that practitioners obtain or update their electronic health information systems. According to Honig Geragosian, this can run a solo practitioner $20-$30k. Further, if they do not achieve this objective they run the risk of having their reimbursement rates reduced.
So what are some of the proactive or positive aspects of this bill? And while it is clear we all want better quality of services, how do we get there, especially in lieu of the expanded population that will now have insurance? Chris Dadlez, President and CEO of St. Francis Hospital & Medical Center, sees opportunity for innovation and integration through the use of initiatives that align incentives to outcomes and toward the use of evidenced based medicine. Through such initiatives he feels that providers will be forced to consolidate and integrate to produce outcomes. Marcia Petrillo, CEO of Qualidigm also feels that this law introduces a national/global strategy for quality that will champion evidence based medicine. A couple of the panelists agreed that mergers and acquisitions among insurers and providers will be prevalent over the next few years. It is arguable that this would be the next logical step as they are faced with having to improve quality and manage access simultaneously as well as to cope with the new payment restructuring, etc. Other creative products likely to emerge out of this legislation are concierge medical plans where patients pay a flat fee upfront for unlimited access to their primary care physicians, and the advent of enormous health care provider conglomerates with a Wal-Mart like business model were imagined. Yes, imagined for now, but quite likely a reality in the next decade.
In summary all predicted that this legislation will undoubtedly require many legislative fixes as it is rolled out, but that on the positive side it will definitely espouse a new level of competition among providers and insurers alike. In addition many believe that the level of transparency and measurement of providers that this law enacts will help inform the public and empower them to choose providers accordingly, and providers that perform the best will be rewarded while those that don’t will naturally languish. The panelists are hopeful that the ensuing competition will also drive the promotion of prevention and wellness models, a noble and most worthy ideal in these times.