Future of Healthcare in America

The National Institute for Health Care Management Foundation www.nihcm.org (NIHCM) hosted a panel of healthcare leaders with diverse business and policy expertise to share their ideas on the state of ACA implementation and the future for healthcare in America. The briefing was held on Capitol Hill on September 3rd.

The featured keynote speaker Marilyn Tavenner, Administrator for CMS http://cms.hhs.gov discussed how the availability of insurance for many adults and children has improved. In 2014, consumers were able to choose among 47 plans and 7 out 10 consumers were able to receive coverage. In addition, there has been a 9 percent reduction in hospital infections, reduced hospital readmissions, and an emphasis on establishing accountable care organizations.

J. Bradley Wilson, President and CEO, Blue Cross Blue Shield of North Carolina, www.bcbsnc.com wants to see consumers play an increased role in their own healthcare. To do this, consumers want insurers to provide transparent information on how to navigate the healthcare system and provide easy to understand materials to help them walk through the process.

Wilson pointed out, “To help consumers, BCBS is rolling out tools with specific information on how to obtain access to healthcare. For example, BCBSNC is helping consumers find information when they are in trouble or have an emergency through their mobile phones. Information is given on the location of urgent centers and if needed, the location of the closest emergency room.”

He added, “There are several trends in North Carolina but one of the most important trends includes bundle payments where a single fee is paid for services. In this case, one payment covers everything from pre-op care to the procedure itself to follow-up and then to physical therapy if needed.”

Another trend not only in North Carolina but in many other places are patient-centered medical homes. In North Carolina, the health system created a model called Carolina Advanced Health www.carolinaadvancedhealth.org  where the entire care team works together consisting of the doctor, physician assistant, nurse, nutritionist, behaviorist, clinical pharmacist, and a care manager to ensure that all of the patient’s needs are met under one roof.

Joseph Swedish, President and CEO, WellPoint, Inc. www.wellpoint.com mentioned that changes in healthcare delivery, consumer engagement, rapidly emerging technology, greater connectivity to health information, and increased provider collaboration have vast potential to save lives and truly transform care for millions of people.

However, the country needs to advance beyond the present fragmented disconnected system to produce a system that will improve quality and safety and at the same time, produce a value-based payment system.

According to Swedish, “Advances in technology and analytics will be game changing since providers will be able to make better decisions. By using technologies such as telehealth, there will be a shift to quicker access to care and better cost performance.”

He added, ‘It is important to present the best information to health plans, providers, and consumers by developing Clinical Data Repositories to consolidate data from a variety of clinical sources capable of presenting a unified view of a single patient.”