In today's Crain's Cleveland Business, Author David Schweighoefer of the Cleveland-based law firm Walter & Haverfield offers a common sense "User's Guide" for those trying to figure out Healthcare Reform and what it means. I'll call it "Take a Deep Breath and Keep These 7 Things In Mind..." I especially like #1:
Separate: Strive to separate politics from the law.
These 7 points are a quick read - It is so good and so simple, in fact, that I'll run it verbatim on Ankota's blog. Enjoy!
No one should underestimate the scope and complexity of the recently upheld Accountable Care Act. Everyone wants to know, “what does it mean?” and “what happens now?” Readers are being bombarded with explanations and projections and hypotheses. Exactly what it means depends on your age, gender, current health status and if your questions are from the standpoint of an individual or a business owner. Here are a few simple rules to keep in mind as you proceed with your analysis:
1. Separate: Strive to separate politics from the law. This legislation has become enormously politicized, and that clouds understanding of what exactly the legislation attempts to accomplish.
2. Observe: Our present health care system, in comparison to other civilized nations, costs too much, is too complex and delivers sub-optimal results. This legislation is an ambitious attempt at reform and repair. Change is difficult.
3. Analyze: It has become a political issue because we as citizens do not agree on the proper size of the role government should play in our lives, and in this instance, our health care.
4. Contemplate: We have a moral dilemma. What is our responsibility to care for our fellow citizens? Should health care be a human right? In this regard, why are we so different from other civilized nations? Many European nations have successfully implemented the changes contemplated by this legislation, a task made easier by fundamental differences between those societies and ours. Many other societies have a belief that their members have an obligation to each other rather than a belief that individuals are only responsible for themselves.
5. Ask: Ask: What does this legislation propose to do? It provides for insurance reform: (i) more people are covered with insurance; (ii) insurance becomes more accessible through the expansion of Medicaid and insurance exchanges; (iii) coverage is better (young adults covered until age 26, preventative care is covered, your insurance company must spend a certain amount of your health care premium dollar on your care) AND…..
The legislation proposes delivery system reform: (i) care will be better integrated and coordinated through a variety of new structures, one of which is named an Accountable Care Organization; (ii) this new care system will be paid differently -- rather than a fee for every service provided to you, the providers will receive a bundled payment to split among themselves, the amount of which will not depend on their respective fees, but rather on the outcome of your care; (iii) an increase in attention to the quality of your care; and (iv) increased efforts at developing innovation in the health care system.
6. Calculate: This legislation has dozens and dozens of moving financial parts and pieces. Some costs will go up, others down. Still others will shift. Political explanations of these changes are political explanations of these changes. In order to understand the financial impact on you, you will need to carefully investigate the changes as they apply to your situation.
7. Examine: It is tempting to believe that the simple operation of the marketplace can be relied upon to correct these many ills. To date, this has not been the case. Markets function best when they operate under certain conditions, one of which is when a large number of sellers compete with each other over prices that reflect the true resource costs. The other necessary condition is when the consumer has good information about the characteristics of products and their prices – information that is most easily obtained if products are well defined and standardized and if prices can be readily ascertained without excessive search. Our current market for health care does not meet these conditions.
Watch for additional blog postings in coming weeks as we endeavor to explore these guidelines in more detail. Until then, consider just one aspect that seems particularly riveting: In the long run, can the states really afford the expansion of Medicaid?
Ankota's technology is used to organize providers of all types into "ecosystems," enabling Accountable Care models with technology that helps organizations Plan, Coordinate, and Deliver services in a highly coordinated and efficient manner. To learn more about Ankota technology for ACOs or to manage Care Transitions, click on this really cool orange button!