Healthcare reform expert: Next phase will be rockier than the first

Although the country is still struggling with the challenges of the first phase of healthcare reform, a leading health economist and policy expert predicts the next phase will be even more difficult as the market demands accelerated changes that involve paying for neccessary care and forcing pricing transparency into every facet of health system operations.

Paul Keckley (pictured), Ph.D., executive director of the Deloitte Center for Health Solutions in Washington, D.C, and a leading expert on U.S. healthcare reform, wrote in his last weekly healthcare memo before his retirement from the company on Friday, that Healthcare Reform 1.0 was based on the Affordable Care Act's premise on full economic recovery by 2014 and stability in world affairs.

But economic recovery is slower than anticipated and the ever-changing world events will likely strain the country's defense resources and global trade efforts, he said.

"In Health Reform 2.0, the market will force acceleration of changes that need urgent attention," Keckley wrote. "The market--employers and consumers--will force the system to resolve its intramural tensions--between insurers and providers, primary care and specialty physicians, government regulators and industry operators, innovators and risk takers ready to test new solutions and regulators inclined to make it more difficult than what might seem reasonable."

Furthermore, he said the market will weigh in on the balance between profits and purpose, transparency about quality and costs, regulation, ethical business practices, consolidation, executive compensation, and boards that serve independently.

Health Reform 2.0 means every sector in the system will face uncomfortable changes and for some, redefinition of their role altogether, Keckley noted. "Discussions about the effectiveness of the healthcare system on main street will be more frequent, more compelling and unavoidable."

Keckley predicts the country is on the cusp of an "Occupy Healthcare" movement--similar to Occupy Wall Street--because the healthcare system hasn't responded to the market's needs and values. "While many in the healthcare system have prospered even since the passage of the ACA, increased numbers of consumers and employers have fallen under the weight of its costs and the ranks of those without coverage is at all-time high," he said. "That's the context for Health Reform 2.0."

In an exclusive interview with FierceHealthIT last year, Keckly talked about technological barriers to Healthcare Reform, including lack of access to data. "If you look at health reform in the broad context of Meaningful Use and ICD-10 as elements of that--and that the Affordable Care Act merely assumes that those are implemented--it doesn't presume that those have been delayed or set aside. I think that's been the missing link," he said.

Following his retirement from Deloitte, Keckley plans to continue teaching, researching, writing and speaking about healthcare reform. "I am not leaving the industry," he wrote in the farewell memo, adding that "never in my 35-year career have the stakes for the future of the industry been so high and never has there been such tension in the system that negates honest pursuit of solutions. It's not about bad people: it's a flawed system and it's the system that will be the focus in Health Reform 2.0."

To learn more:
- read the memo