Change Is Coming—With or Without Health Care Reform

Since I do a lot of work with clients in the health care industry, I have been watching the developments in health care reform very closely. I had just written about the need to make the complexities of health care reform understandable to the public when the Supreme Court hearings created reasonable doubt about the future of this legislation. Regardless of the outcome, I would argue that the process of preparing for health care reform has already served as a valuable catalyst in changing the industry’s approach to delivering health care.

One of the most significant aspects of health care reform has been a greater recognition of the need to develop better and more efficient preventative care for low income and uninsured populations. As health care providers and community health organizations have been preparing for an increase in this patient population, it has become apparent that our current system is not providing our underserved preventative care to help keep them out of our most expensive facilities – emergency rooms. The process has opened the eyes of many to the fact that insurance coverage alone will not address gaps in our ability and capacity to provide medical, mental health, dental and social services. As a result, communities are beginning to collaborate with health care providers, safety net clinics and local service agencies to fill these gaps. This is a positive change in our approach to care that is needed regardless of the health reform outcome. Visit washtenawhealthinititive.org to see how Washtenaw County is preparing to address the care needs of our community.

Electronic Medical Records is another change that will improve our ability to care for patients. The 2009 Stimulus package subsidized providers to switch from paper to help streamline care and reduce errors. From a patient perspective, it will mean that health records are more complete and more easily accessed by multiple physicians, and will reduce duplication of paperwork.

Payment for health care is also changing. We are likely to see a shift from “fee for service” to a “performance” based model. The new payment structure is designed to shift payments to providers who are paid based on the quality and efficiency of the care they provide. In other words, physicians/hospitals are given a financial incentive or reward for using more cost-effective ways to care for their patients.

The Center for Medicare and Medicaid Services is also testing other payment and care delivery models (e.g. bundled or “global” payments, medical or health care homes, care transitions, value-based purchasing) through providers participating in Medicare. It is worth noting that CMS and HHS can implement their payment regulations on their own without the Patient Protection & Affordable Care Act.

Tremendous resources in terms of time, money and technology have already gone into the development of processes and systems to support the new health reform regulations. The progress that has been made so far has already gone a long way towards providing more people with more efficient and quality care. Regardless of reform, it is clear that change is here to stay.

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