On Thursday (June 2), I joined other speakers at the IBM Healthcare Leadership Exchange, Transforming Healthcare, held at the Chicago IBM Transformation Center. My keynote presentation focused on “Healthcare in the US,” which seemed to balance the morning with the opening keynote by Susan J Hyatt, BSc (PT), MBA, CEO HyattDIO, Inc., Ontario, Canada, who discussed “Global Lessons on Delivering Strategic Healthcare Wins.”
Any discussion about the current U.S. healthcare climate must begin with the policy conundrum now in play in Washington, D.C. This longstanding tug-of-war between progressives and conservatives seems to be exacerbated by the current budgetary climate. Everyone wants on the public policy wish list, but the trillions of dollars in debt are starting to weigh on the decision-making.
Policy discussions are at the focal point of divergent societal perspectives and social values, such as:
• is healthcare a right or a privilege, and
• individual or employer mandate.
No matter which side anyone sits on, many possible policy solutions now exist for the challenges facing American healthcare. And those options must be economically feasible, socially acceptable and politically viable.
But successful and comprehensive healthcare reform must also address these four basic issues.
1. The rising cost of delivering and financing healthcare,
2. The challenges of rising chronic illness and an aging population,
3. The paradox of quality in American healthcare, and
4. The uninsured.
The current situation calls for quick fixes that remedy the situation now, but don’t really take on the deep-rooted symptoms of malaise. Such remedies include payers returning to managed care with more emphasis on chronic disease management, care coordination and medical homes.
Providers could take on increased risk for better profits with value-based purchasing, where buyers hold providers of healthcare accountable for both cost and quality of care; bundled payments, ACOs and medical practices.
We know policy decisions now operate with the House pushing for repeal, with the Senate on the opposite side in favor, of healthcare reform. Despite calls for and fears of losing incentive payments, the most likely outcome is “death by a thousand cuts” of the healthcare reform law. Even with HHS spending lots of time on the Hill with hearings, letters and subpoenas, few significant changes are expected…resulting in no impact on HITECH incentive payments…maybe.
Here are the maybe options health reform opponents have, and could have, in mind:
• Cut down the law provision-by-provision,
• Defund the law,
• Come up with an alternative; i.e. RyanCare, -Defined benefit becomes defined contribution -Medicaid block grants to states
• Delay implementation of the law,
• Launch an overnight campaign, and
• Take control of the Senate and presidency in 2012.
The 2012 election will determine what happens to healthcare reform for the next 2 to 4 years, with a Supreme Court ruling expected in that same year. But in the meantime, the Congressional Budget Office, the independent, non-partisan budget expert for the U.S. Congress that scores every piece of legislation, has scored HR2 – or Repealing the Affordable Care Act – as adding $230 BILLION to the federal deficit.
Now enter health IT, an enhanced means to an end that provides valuable patient health information. This critical tool can:
• Collect data & provide decision support tools, especially at the point of care, and
• Share data b/w providers, payers, policy makers, and consumers.
Remember, the goal is more effective and efficient healthcare purchased on the basis of value and outcomes rather than just unit cost.
Thus, seismic shifts in healthcare are a question of “when,” not “if,” health IT can and should play a major role in this evolution.