WASHINGTON, D.C.—Though much of the debate around a Republican-led effort to repeal and replace the Affordable Care Act (ACA) has centered around insurance and reforms to the law’s coverage mandates, for providers some of the biggest, and best, changes came from the law’s push for payment and delivery innovation.
New payment models, increased emphasis on health IT and putting a spotlight on population health are all ways that the ACA helped push providers to offer better, more effective care, according to a panel hosted by the Center for Consumer Engagement in Health Innovation.
Donald M. Berwick, M.D., president emeritus and senior fellow at the Institute for Healthcare Improvement, said he views the ACA as two separate “laws” because of its dual themes: offering more and better health insurance and innovating care delivery. He said the repeal effort could really hinder, if not completely cease, efforts toward innovation.
“I think we’re here to defend progress toward what we call the Triple Aim,” Berwick said. “All three [aims] are achievable, all three show progress and all three are vulnerable. It seems to me incumbent upon those who claim to lead healthcare and healthcare systems to defend that progress against threats."
Berwick was joined at the panel by Steven M. Safyer, M.D., president and CEO of Montefiore Medicine; Shelly Schlenker, vice president of public policy, advocacy and government relations for Dignity Health; Timothy Ferris, M.D., senior vice president for population health management with Partners HealthCare; Glenn Crotty, Jr., M.D., chief operating officer for the Charleston Area Medical Center Health System; and David Blumenthal, M.D., president of the Commonwealth Fund.
All six panelists defended the ACA’s emphasis on innovation as critical and praised Medicaid expansion as being beneficial, while also noting that the healthcare law has its flaws. Uninsured people are a significant financial burden on the healthcare system, and access to benefits like Medicaid can keep people from making unneeded visits to the emergency department and can connect them to key primary care services.
Safyer said Montefiore has seen the benefits of expanded Medicaid firsthand, as it treats a largely poor patient population. He said the system has been striving to move away from the traditional fee-for-service model for more than 20 years, and that he dreads the possibility of having to return fully to that form of payment.
"I’m worried that at some point I would be faced with a decision, as a fiduciary decision, to trade out what we’ve built and go back to fee-for-service,” Safyer said, “and to me, that would be the biggest failure and the hardest thing I can ever do in my career.”
Schlenker said Dignity Health has made great strides in population health while also acknowledging that they cannot treat every social determinant of health. She said community partnerships that bring in outside stakeholders has been key. For instance, homeless patients are not discharged back to the streets after a stay but instead are sent to a recuperative shelter while they continue to heal, she said. The system also has programs that work with local organizations to find them housing.
Dignity Health also designed a referral program that connects patients in need with outside agencies that can help them. In one case, a woman who had just given birth was on emergency Medi-Cal benefits to cover labor, but the hospital was able to connect her with Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP) and Medicaid benefits to help care for her new babies, Schlenker said.
“The way we’re doing all this, we’re beginning to see the tangible results of a much broader view on healthcare,” Schlenker said.