By: Scott Armstrong, Chair, ACHP Board of Directors; President and CEO, Group Health Cooperative
These days, I often find myself trying to answer questions about the future of health care reform.
Whether it’s a formal event that I’ve been asked to speak at, a meeting with Group Health employees, or a conversation with friends over dinner, people want to know how I think the Supreme Court will rule on the Affordable Care Act. Or what to expect if President Obama wins—or loses—the November election. Or how things might change if there’s a Republican majority in the Senate.
Of course these are unanswerable questions. So I give them the only honest response I can—that with so much uncertainty, it’s impossible to predict.
Then I tell them what I do know, which is that no matter what happens on the political scene over the next six months or so, we’re in for a period of difficult change. There is just too much about health care in this country that is inexcusable and unsustainable.
But I also tell them that while this may sound unnerving, there’s reason to be optimistic about the future. That’s because the process of reform is already underway, and it will continue no matter what happens in Washington D.C.
ACHP members are at the forefront of this change. We have long recognized that what really makes a difference is what happens when patients are engaged with their care providers in a relationship focused on their health. And that what ultimately determines the quality and cost of medicine is how patients access care at a local level, the decisions they make about diet and exercise, the steps they take to manage their chronic conditions, and the procedures they choose.
This is what makes ACHP so important. We are an organization of regional systems that are pioneering innovative ways to meet the needs of individual patients in the communities where we work. Rather than waiting to see what the Supreme Court decides or who wins the election, we’re already finding solutions that are transforming the care we deliver. And rather than waiting for policymakers to tell us what we can do, we’re sharing what we’ve learned with them, and with each other.
What we’ve learned is that while there are many different ways to organize health systems, the foundation for better results must be built on certain elements.
These elements include integrated care systems that focus on prevention as well as treatment and that apply evidenced-based clinical standards that are supported by information technologies that connect patients and care providers to each other and the information they need. Our systems help patients engage as owners of their own health, supporting them well beyond the medical exam room and out into the community. And perhaps most important of all, we are proving that provider payment structures and benefit designs that reward better health outcomes can drive more affordable care.
To put these principles into practice, we’ve developed tools and approaches that we use every day to deliver care that is more effective, more affordable, and more compassionate: electronic records that improve access and convenience for patients, and eliminate duplication and waste; decision-making processes that help people choose the treatment that is best for them rather than the provider’s bottom line; and teams of providers that are paid to focus on prevention and primary care rather than high-cost specialty procedures.
It’s not an accident that 98 percent of the Medicare patients in this country who are enrolled in Medicare five-star plans are served by ACHP members. By moving beyond the waste and fragmentation that is inevitable with fee-for-service medicine, we are providing exciting models of integrated care and coverage that truly help people live healthier lives.
This is where the work that ACHP does with policymakers is so important. While we know that the answers we seek must come from the kinds of local innovations that we are pioneering, how they get translated into system-wide changes will be critical. That’s because health care is not like other businesses. We are a highly regulated industry in which state and federal governments play a huge role in paying for care through entitlement programs, government employee health plans, and tax policy.
To achieve reform at the scale that this country desperately needs, we must continue to encourage policymakers and elected leaders to recognize how important it is for Medicare and other public programs to pay for value, not volume. We need a policy framework that does more to reward quality and encourage coordination—not simple market consolidation.
The truth is that when the Supreme Court hands down its ruling, we’ll have a lot of work to do to figure out how to respond. The same will be true in November, when we’ll learn what the balance of power will be in the White House and Congress.
But we can’t let this uncertainty distract us from the work we’re doing every day to enable patients and doctors to work together to ensure that everyone receives personalized, compassionate, comprehensive, evidence-based care.
This is what we are good at. And it’s where the real answers to the health care crisis—in the innovations we deliver in local communities.