How the ACA led to change this year at one California hospital

Although the Affordable Care Act (ACA) has made sweeping changes to the healthcare industry at large in the past year, it has also led to changes on a ground level in individual hospitals, a hospital chief medical officer (CMO) writes in Time.

Post-ACA, writes Chester Kunnappilly, CMO of California's San Mateo Medical Center, many of the organization's patients are newly eligible for Medi-Cal, the state's Medicaid program. California was the first state to expand its Medicaid program under the ACA. As a result, these patients gained access to a number of previously unavailable services, such as dental treatment and mental healthcare, as well as increased access to healthcare within their community rather than having to travel a long distance to other facilities.

Before the ACA, Kunnappilly writes, the majority of Medi-Cal patients were either uninsured or enrolled in a program through San Mateo County that only covered services at the San Mateo facility. Their increased range of options meant an unprecedented amount of pressure and competition at San Mateo, forcing the hospital to innovate to survive. It had a head start on many of these innovations, he writes; for example, county hospitals implemented a plan for electronic health records long before it was mandatory to do so, and new funding mechanisms under the ACA allows San Mateo to take advantage of its existing infrastructure.

"We have repurposed some staff roles and brought in new staff members with new skill sets," Kunnappilly writes. "For example, we have staffers who are specially trained to extract information from electronic records to better manage chronic disease, and pharmacists have been added to some primary care teams to assist with medication management."

Furthermore, he writes, no longer being a last resort has allowed San Mateo to explore alliances with other community providers, giving the hospital an opportunity "to focus on those services that we provide well while partnering to provide services that are best delivered by others."

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