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What’s Going to Happen to Healthcare?

By Ame Wadler

Doctor and patient

Repeal and replace? Repeal then replace? Or just repeal? These are uncertain times when it comes to healthcare. With a new President who has made no secret of his desire to eliminate the Affordable Care Act (ACA) and a nominee under consideration to lead Health and Human Services who has long been vocally opposed to the ACA, there’s no question that change is afoot. But what change looks like remains unclear. And, what change means to public health and the healthcare industry is even cloudier.

What’s at risk?

  • Fewer Americans have access to care because they won’t have health insurance
  • Reduced access for people with pre-existing health conditions
  • Loss of access to wellness and preventative medicine

What could be gained through an evolution in ACA:

  • An elimination of the “premium creep” resulting in higher deductibles and premiums than initially planned
  • The ability to choose whether to be insured or not through an elimination of the insurance mandate
  • The ability for businesses to hire needed employees without the burden of the mandate to impede employment/hiring
  • An ability to define “better” based on one’s individual needs – whether that’s choosing/keeping a physician that is right for them or having health coverage for hospitals and physicians in a reasonable distance from one’s home

Regardless of the legislative actions that will be taken, there are certain issues that will continue to be central to the delivery of healthcare and of critical importance to the industry:

  • Performance-based, value-based care is a given. A key element of the ACA is the move toward risk-based models for health vs. the traditional fee-for- service approach. Whether you refer to the Triple Aim in the US or value-based care as the norm in Europe, healthcare providers will be measured based on their ability to deliver improved outcomes and a better patient experience at a significantly reduced cost. Success in this environment requires an understanding of what constitutes value to each population in question based on their health needs, a more connected care community that puts the patient squarely at the center and a recognition that data must inform metrics. In the current political limbo in the United States, this may mean that institutions and healthcare providers slow down investments as they assess where investment may pay-off. However, investment in insight-driven technology today may in fact, expedite the path to value-driven outcomes.
  • Transparency Drives Consumerism. Never before has the patient had so much information at their fingertips when it comes to healthcare decision-making. From healthcare insurance providers to doctors and even hospital systems, the patient has the opportunity to “comparison shop.” This transparency means that some consumers will make decisions based on cost – especially as they pay for more care themselves in the forms of non-reimbursable care or higher deductibles. Educating patients on “Value” vs. “cost” will be critical to enable people to make the best choices for themselves and their families.
  • The Consumer Voice Matters. With patient experience bound to be a continued performance metric, it’s critical that the healthcare community truly understands what that means via the voice of the patient. A patient’s experience with healthcare begins from the very moment they choose to make an appointment for a wellness visit to their understanding of the side effects of medications they’ve been prescribed. Adding convenience and clarity to the experience can create the compliance and well-visit loyalty that can improve health and keep costs down.

Whether the legislature repeals, replaces or leaves things as is, delivering a positive consumer experience that motivates people to appropriately use the health system to protect health as opposed to fix health is where the true value will be delivered.