There is much talk about the issues Obamacare is causing in regards to healthcare in America. Some of these complaints include increasing deductibles, high insurance rates, narrow networks, access to care, and a shortage of physicians. What isn’t being talked about as much is how health reform is changing healthcare in America for the better.
Overall, health reform will serve to provide us with better quality care, value-based care instead of fee-for service, more collaborative and integrated care, better chronic care management, safer hospitals, better healthcare spending, and a move to well-care instead of sick-care. Will it take time to get there? Yes. Will there be some chaos in the process? Yes, but you can’t overhaul a system without disruption taking place, even if that overhaul is for the better.
Hospitals now have to complete Community Health Needs Assessments (CHNA) and implement strategies to improve population health, and they are given penalties for preventable readmissions. That means there is a bigger focus on prevention and wellness to reduce unnecessary care, hospitalizations and readmissions. Healthcare is moving to a system that promotes and earns income for keeping people healthy instead of simply treating them when they are sick. This will ensure better health and wellness of populations.
The ACA has brought increased pricing transparency, and with that comes downward price pressure and increased value. Consumers have greater control over their care and receive better value for their healthcare dollars. They now have the right to receive numerous preventative services at no out-of-pocket cost. Insurance companies are now covering more prevention-related services for women, including well-women visits and breastfeeding support and supplies.
With a shift from fee-for-service to bundled payments that cover episodes of treatment instead of each individual service, providers are now incentivized to integrate their services and work together to help each patient get and stay healthy. Care management and coordination is now a priority for providers as a result, and that will serve to improve the quality of care as well as health outcomes.
Value-based payments now exist in an effort to promote higher quality, safety, and efficiency, while reducing use at the same time. Instead of receiving payments for services rendered, providers receive payments based on performance, which is determined through quality measures.
Expansion of healthcare coverage under the ACA is made possible by the expansion of Medicaid eligibility. This is optional on a state-by-state level. In addition, providers are now improving patients’ ability to access healthcare. Some of the changes they are making include:
Care Coordination Services – Care coordinators help patients navigate the complexities of the healthcare system, coordinate their multiple healthcare providers and medications, and point them in the right direction. CarpeVITA Health provides a unique care coordination solution that helps patients predict, prevent, personalize and participate in their health.
Telehealth – In some cases, patients are now able to consult with physicians over the phone or via video conferencing. There are state-by-state differences for coverage, but this option is starting to become more available.
Call Centers – For small healthcare providers who have limited office staff, fielding calls through a call center helps ensure patients’ calls are answered. These centers are available to take messages, provide reminders and schedule appointments.
Open-Access Scheduling – Many providers are now offering same or next day appointments by leaving more openings in their schedule. Many are booking future appointments only 2-3 weeks out instead of months out, so that there are less cancelations and no-shows. The theory is that when people are seen immediately, they are more likely to get the care they need so that they don’t end up in the emergency room.
More Nurse Practitioners & Physician Assistants – With a shortage of primary care physicians, some offices are utilizing more nurse practitioners and physician assistants, who are more than capable of assisting patients with many common issues, such as strep throat, sinus infections, ear infections, urinary tract infections, bronchitis, ringworm, and more.
New consumer protections are in place to put an end to insurer practices that get in the way of people receiving the coverage they need. For example, insurers now have a limited ability to deny, limit or cancel coverage and to impose annual and lifetime spending caps. Coverage for people with pre-existing conditions and young adults is extended as well.
By providing more people with affordable medical insurance and by working to improve population health, our community resilience in disasters is improved. This is because when people are healthier going into a disaster, they are more likely to come out of a disaster healthy. Plus, as people learn to participate in their health to maintain a state of wellness, they are better able to address health issues on their own when professional assistance is not accessible in an emergency.
All in all, the ACA is in place to bring about more efficiency, value and quality, while lowering the cost of healthcare. Companies like CarpeVITA Health are making this transformation a reality, ensuring that Americans get healthy, stay healthy and that all the tools, resources and information is easily accessible to be able to manage their health.