By Liz Leonard
While each week in the U.S. different reports come out about key aspects of the US healthcare reform being adopted, implemented or delayed, fewer elements of the Affordable Care Act's (ACA) impact are clear. Amidst conflicting political angles and confusion, fundamental need for change exists—and change is at hand. The how, when and where may not be finalized—but the basic facts remain as certain as death and taxes– a growing population needs better care and costs are too high.
Strain on the system is not unique to the U.S., but some critical points are irrefutable:
MORE SICK PEOPLE—AND MORE OLD PEOPLE.
Capacity issues at hospitals are linked to an aging population, growing chronically ill population and the newly insured population entering the system starting late 2013. Broad needs do not only burden care provider's resources and treatment supplies, but also facilitation of payments and reimbursements, ultimately costing everyone more. Public health insurance exchanges (HIX) are scheduled to launch enrollments on Oct. 1, 2013 across the 17 states thus far participating for live insurance, driving up care provisioning even further.
HOSPITALS AREN'T EXACTLY "WELL", EITHER.
Hospital mergers doubled from 50 in 2009 to 105 in 2012 according to Irving Levin Associates, and this is expected to be the tip of the iceberg. Rapid consolidation of hospitals and care networks across the U.S. is a by-product of ailing business outcomes. Hospitals face lower payments from the federal government and declining patient admissions, as they are no longer being paid on volume, rewarded for filling beds and performing more tests and procedures, but rather are responsible for total cost of a patient's care—resulting in incentive to keep patients healthy, and out of their facilities.
COSTS UP, QUALITY DOWN.
The U.S. outpaces all other countries for expenditures as a portion of GDP (quickly approaching 20 percent), but increased spending has not been an effective Rx for improving the patient care quality or outcomes. Costs consistently rise across public and private insurance plans, and care delivery systems direct the ACA agenda toward integrated health; incentivizing participation in Accountable Care Organizations (ACOs). Whether delving into the entire ACO proposition or not, hospitals are investing to improve clinical integration, applying efforts to operate with greater transparency and accountability to reduce waste, operating costs and improve quality of care. They are getting poised to perform, and spending to get it done right.
The ACA has set deadlines for care providers, public and private insurers, employers and consumers to advance adoption of measurable changes. The net result of reform-led deadlines is the need to integrate, manage, govern and update healthcare data and information better to support not only broad decisions, but very local decisions in a given state or municipality.
Access to care, quality of care and cost of care are universal struggles in healthcare systems globally. In the U.S., healthcare is in a state of accelerated evolution. Healthcare reform calls for increased accountability coupled with cost control and will migrate away from a discussion of changed business models and bottom lines to a discussion of changed personal accountability and role models.
Liz Leonard is an Associate Director, Research for Kennedy Consulting Research & Advisory (KCRA). For more information,visit www.kennedyinfo.com/consulting.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.