What Did We Learn from the Affordable Care Act?

As it turns out, what we have learned thus far from the Affordable Care Act (ACA) is that having a regular source of healthcare, at about the five-year point, begins to have a significant and positive impact on reducing mortality rates, improving survivorship, and improving overall health. And we learned that a consistent source of care is critical to how healthcare creates its value in the 21st century.

 

We also learned, thanks in large part to the ACA, the immediate positive impact of transparency and access to data that gives us the computational power to discover what we can do today from a health prevention standpoint that would benefit patients in five, 10, and 20 years.[1] As a result of the work of the Center for Medicare and Medicaid Innovation (CMMI), which was funded by the ACA, 30 percent of Medicare patients are being cared for by doctors and nurses who are incentivized to keep patients out of hospitals and emergency rooms. This represents a fundamental change from the traditional fee-for-service construct, which incentivizes unnecessary and sometimes harmful testing and treatment. Because providers had more access to patient data, early findings show that patients in value-based care models had lower readmission rates, lower mortality rates, and lower total cost of care. In addition, the level of patient engagement as a result of data transparency is unprecedented. Patients now represent the fastest-growing user group of electronic health records (EHRs) in the United States.

 

What is less clear today are the long-term consequences of high-deductible health plans and the choices patients in these high-deductible plans make to forego taking their medication and seeing their primary care provider. While seemingly a good idea for some (namely the 20-something healthy Americans), high-deductible health plans have surfaced a growing trend where a subset of patients have $2,000 to $3,000 deductibles and are limiting sometimes necessary and important care.

 

 

This post was originally published in a special section for the Governance Institute, under the title, “The 21st-Century Patient Is More Complicated but the Remedies Don’t Have to Be: How Bundles and Other Innovations in Healthcare Payment Are Offering New Promise for Care Delivery,” by Deirdre M. Baggot, Ph.D., M.B.A., RN.

 

 

 

[1] Deirdre Baggot, “The Bundled Payments for Care Improvement Program: A Hospital Analysis,” Becker’s Hospital Review, February 2013.

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