Each issue, Kennedy
& Advisory (KCRA)
offers a take on the
current state of the
Liz Leonard is an
Research for Kennedy
& Advisory (KCRA). For
U.S. Healthcare Reform and Integration
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.
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 pa-
tient’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 expen-
ditures as a portion of GDP (quickly approach-
ing 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 agen-
da toward integrated health; incentivizing par-
ticipation 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 account-
ability to reduce waste, operating costs and im-
prove quality of care. They are getting poised to
perform, and spending to get it done right.
The ACA has set deadlines for care provid-
ers, 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 up-
date 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
BY LIZ LEONARD