Posted: July 03, 2013
Change was warranted, but is Obamacare the solution?Maria Martin
Mention the Affordable Care Act to a business owner, a health care provider or any of the millions of uninsured people who have struggled to pay medical costs, and you’re likely to stir up a lively conversation.
The Affordable Care Act (ACA), officially named the Patient Protection and Affordable Care Act, was signed into law by President Obama in March 2010. Its aim is to dramatically increase the number of Americans who receive health insurance, in part by streamlining delivery of health care and improving patient outcomes.
Many complain that the word “affordable” has no place in the name of the Act, while reactions from individuals who aren’t covered by employers are mixed.
But most of those involved in providing that health care agree on this: The time for change is now.
Debbie Welle-Powell, vice president of accountable health and payer strategies for SCL Health System, says the future is clear.
“We have to get really good at managing the continuum of care for a patient,” Welle-Powell says. “Our focus is on the population health.”
That means connecting everything from outpatient services to prevention to acute care to home care, she says.
“With the newly insured, the system will break us if we don’t start asking questions like how much care is needed, and what kind of care do we need,” she says.
Bruce Johnson, an attorney with Polsinelli, says many of the changes that have swept the country were in the making for years.
“The Institute of Medicine and other groups have focused on the fact that we spend a lot on health care, but we don’t always get a great value,” said Johnson, who has worked with physician practices for 23 years in Colorado.
“It promotes access to health care and it puts the screws down on some of the fraud,” Johnson said. He adds that health care is an essential ingredient in our economy. “Without doubt, there are crooks, and everyone would agree that we should stop that.”
Administrators at hospitals also agree that one of the biggest benefits to the ACA will be expanded coverage, which means fewer people waiting until they are desperately ill and in need of costly emergency room care. Nobody in the industry would dispute that hospitals treating uninsured clients drives up costs.
Simon Smith, executive vice president of Clinica Family Health Services, says the ACA will benefit many of the nonprofit organization’s clients.
In addition to those who will be newly insured, Colorado has expanded the number of people eligible for Medicaid. Many of Clinica’s clients, who were previously uninsured, will have some degree of coverage.
“For us it’s a tremendous opportunity as a community health center,” Smith said. “Increased revenue will allow us to cover costs and hopefully expand our services.”
It will also allow the organization to help people access specialty care.
While Clinica offers primary care services to low-income clients in five medical clinics, it does not cover specialized care, and uninsured clients may have nowhere to turn if they need specialists such as dermatologists or cardiologists.
“The biggest challenge we face is that there are barriers to accessing specialty care,” he said.
“The origin of the term ‘accountable care’ is making health care providers accountable for the care they provide,” said Rulon Stacey, president of University of Colorado Health. “In the past, if the treatment was not good, there was no financial risk for the provider. Now you have a financial incentive to keep people healthy, as opposed to fixing them when they’re sick.”
Grant Wicklund, president and CEO of Exempla Lutheran Medical Center in Wheat Ridge, says factors like readmission rates at hospitals will now be examined. One key, he said, is to work with patients closely to ensure they are taking the steps they need to stay out of emergency rooms.
“We have a very targeted readmission program designed to reduce readmissions,” Wicklund said, noting a drop
in heart failure returns. Exempla Lutheran has also worked with the community on smoking cessation programs and obesity initiatives.”
But with an aging population, the hospital faces challenges, Wicklund said, noting the high percentage of seniors who are noncompliant when it comes to taking their medications and following doctors’ orders.
Stacey agrees that the push to hold hospitals and physicians responsible for patient health does not sit well with everyone.
“If you hold physicians responsible, it leaves providers responsible for the actions of the patients, and some physicians don’t care for that,” he says.
The key to bringing down costs is combining the resources of medical centers and implementing electronic medical record systems, say doctors and hospital administrators.
University of Colorado Hospitals are spending more than $130 million system-wide to implement an electronic medical record system from Epic. UCHealth encompasses five hospitals, a medical group and dozens of clinics. It also manages a hospital in Wyoming and another in Nebraska.
SCL Health System, which encompasses nine hospitals and five clinics, including Exempla Lutheran Medical Center and Exempla St. Joseph’s Hospital, also implemented Epic’s digital record system.
Maria Martin is a freelance writer.