Driving Forces For Health Care Reform - How Important is the Government?
A recent update on the rulemaking by Medicare to define the nature of accountable care organizations got me thinking about the drivers for global payments and "health care reform." There is lots of controversy in Washington right now about whether the shifting politics of the makeup of Congress will affect the implementation of the current version of health care reform legislation in the form of the Accountable Care Act.
While legislation in Washington and the state of Massachusetts will certainly affect payment for care delivered to patients, I'd argue that the real drivers have nothing to do with government. The demand for value in healthcare comes really from the economy. The value equation is literally calculated as service outcomes plus medical outcomes divided by cost. The economy will demand better outcomes and lower cost simply because we are spending too much of our resources on health care compared to other societal priorities.
Our patients are driving this. The recession has reduced their employment, their benefits, and now other costs for families are rising – gas being the most recent. As state and local government frantically reduce services to balance their budgets, health care simply has to deliver more value. We are already bankrupting (literally) too many families. The insurance companies sometimes behave badly, yet they are the middlemen between the economy and healthcare, passing along the message that cost and price need to go down.
So it doesn’t matter whether Republicans or Democrats make the decision, or whether it is federal or state government driving; health care will consume less of our societal resources because it has to do so. The pace and style of the change may be influenced by government, not so much the result. If our society is too slow at addressing it, then the care will get even worse — continued fragmentation, worsening access as prices drive it down, and value will deteriorate further before it improves.
For those of us delivering health care, the moral and economic imperative is very clear: improve the value of care as fast as we can. That means more integration and cooperation among providers, lower cost, better outcomes, and better patient experience. Our patients want this. Our communities need us to get there. The time to begin the experimentation is now, even before government or insurance change the way care is paid for. It will take time to reorganize and improve. Many places have figured out how to deliver better outcomes at half the cost. We can do it also.
Cooley Dickinson Hospital • 30 Locust St. (Route 9), Northampton, Mass. • (413) 582-2000
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