Healthcare in 2016: Boundless Opportunities to Make a Difference

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It is one of the most invigorating times to be thinking about, caring about, talking about and working in healthcare. There continues to be great progress for the better, despite the many hurdles, twists and turns along the way.

This isn’t always obvious. So much of the healthcare conversation is approached narrowly through political or economic lenses. And it can get complicated. That’s why it’s important to keep some things that are actually quite basic in mind, especially about the role of communications in improving just about every facet of how the healthcare system operates and the outcomes that result.

One of the most fundamental shifts taking place right now is the shift from fee-for-service to value-based care. The Patient Protection and Affordable Care Act (ACA) generated an array of new organizations and payment models aimed at improving both cost savings and quality of care. This falls within a larger movement toward improving care quality and outcomes by making it more patient-centered.

As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), by 2020 physician practices meeting not only process improvements but also quality and outcome improvements will be reimbursed by Medicare at a substantially higher rate than those who don’t (and those who don’t will be subject to reimbursement penalties). This marks a dramatic shift in how doctors are to be paid and, according to a report from the Physicians Foundation, many are finding the prospect daunting enough to think about throwing in the towel once and for all by retiring.

Many factors contribute to delivering patient care that improves outcomes, and the entire system will be challenged in ways large and small as new payment models are implemented. But one essential of quality care is – and always has been – the efficacy of the dialogue that takes place between clinicians and patients so that well-informed treatment decisions can be made, and so that patients are more engaged in what they themselves need to do to maintain good health or to manage acute or chronic illness. A recent article in Health Affairs said it best: “Patients are the most underutilized resource to help reach positive medical outcomes.”

One unique payment model – the Pioneer Accountable Care Organization (ACO) Model, which was developed as a pilot program through the ACA – brought $384 million in savings to Medicare in 2012 and 2013 combined, while providing high-quality care. And there was this interesting result: patients in the Pioneer ACOs reported higher ratings in timely access to care and clinician communication compared to those reported by FFS Medicare beneficiaries as a whole and their Medicare Advantage counterparts.

Before anything else, however, people need access to care. And right now, for better and worse, access is structured about the ACA. Word has it that the ACA is in a “death spiral.” This has been a perennial diagnosis since it’s inception.

The latest inflammation in the “death spiral” narrative was triggered by the highly-publicized retreat of Aetna and United Healthcare from participation in many state-run health exchanges (ostensibly due to significant losses on the exchanges but also, at least in the case of Aetna, following a Justice Department ruling against its planned merger with Humana). A closer look at the challenges reveals, among other things, a need for greater engagement with hard-to-reach segments of communities (including healthy young millennials) about the value of coverage, preventive care and the actual options that exist on the exchanges at local levels, so that pools of beneficiaries are better balanced between those who are healthy and those who are less so.

The movement toward a more sustainable system that better meets the needs of individual patients and whole communities seems, to me, to be inexorable, and the opportunity for communicators to make a difference seems boundless. There’s a lot to do and it is an inspiring time to be part of the conversation.