Part I: Some Health System Changes Will Stay, No Matter How Scotus Rules
By Jay Hancock
KHN Staff Writer
Provided by
Kaiser Health News.
Jun 19, 2012
The 2010 health law launched what insurance executive Brad Wilson calls "the revolution" unprecedented efforts to expand coverage, contain costs, cut waste and improve care.
So Blue Cross and Blue Shield of North Carolina, where Wilson is CEO, started paying bonuses to doctors who improve efficiency, nudging consumers to shop around for treatment, urging caregivers to communicate with patients via email, paying doctors to install computerized records and even going into business with doctors and hospitals.
Now the Affordable Care Act is in jeopardy, but many of the reforms it encouraged aren't, Wilson says. Soaring costs, tight budgets, better technology and industry consolidation ensure health care wont go back to 2009 no matter what the court or Congress do, say analysts and industry officials.
If the law is thrown out, "will you have to go back and recalculate? Of course," Wilson said. "But the genie is out of the bottle. Were far enough into the revolution now that I dont see how the political leadership can completely sweep it away."
A decision to strike down all or part of the law would threaten the expanded coverage that many see as its signature feature. But the act also triggered new attempts to move away from "fee for service" insurance, in which medical providers are paid for each visit and procedure, and toward rewarding efficiency and quality.
While some of these efforts began years ago, the law accelerated and multiplied them. Looming costs associated with an aging nation ensure theyll continue no matter what, said Chas Roades, chief research officer with the Advisory Board Co., a health care consulting firm.
"Whatever else the Supreme Court does, they cant overturn the aging process, and theyre not going to strike down chronic disease," Roades said. "Those are factors that are at the root of our health care crisis, and were going to have to continue to figure out ways to address them."
Doctor practices will increasingly be owned by hospitals or insurers or at least work more closely with them, analysts say. Hospital systems and health insurers are likely to continue to merge. Consumers' choice in physicians and hospitals may shrink as plans steer patients toward lower-cost care.
That sounds like the "managed care" of the 1990s, when employers and insurers tried to control expenses through restricted networks and alternative payment models. Those efforts fizzled when patients rebelled and a healthy economy enabled industry and government to absorb rising medical costs with relatively little pain.
Many doubt the new managed care, delivered through networks known as accountable care organizations and medical homes, will control costs any more effectively. Accountable care organizations could give dominant physician and hospital groups a new way to raise prices and profits, some worry.
"Im very skeptical" that accountable care groups will save money, said Glenn Melnick, a health economist at the University of Southern California. "The ACO may in fact be able to manage care more efficiently, but that doesn't mean those savings are going to be passed on. You may have consumers getting less service at higher prices."
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