How to Build On the Affordable Care Act

I continue to believe in the president's vision of a more equitable, sustainable, accessible health care system. As a company, Health Care Service Corporation will continue to support efforts to expand access to quality health care in the areas we serve.
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With presidential election season upon us, I think back to 2008, when then-President-elect Barack Obama asked me to join his administration to work on fixing what ailed American health care. His answer, as we would all learn, was the Affordable Care Act (ACA).

Signed on March 23, 2010, the law has clearly done a lot of good, in spite of its rocky startup, two Supreme Court challenges and numerous other attempts to derail it. It has helped an estimated 20 million people gain insurance, it allowed people up to age 26 to stay on their parents' coverage and it eliminated denials of coverage due to preexisting conditions.

The ACA is not a perfect law but it is an important start to reforming our health care system. On the ACA's sixth birthday, it's worth stepping back to discuss what needs to be done to fulfill the promise of a more equitable, sustainable, accessible health care system. More people now have access to health care, but as an industry we need to continue improving upon the system they have access to.

Though by no means a complete list, there are a few crucial things that need to happen as health care leaders look to put the ACA on a sustainable path and build on the progress that has already been made.

Stabilize the risk pool
Through the first years of the ACA's health insurance marketplaces, the consumers that have signed up have tended to have higher rates of chronic disease and require more care than the general population, meaning their health care expenses have been higher than expected. This led to heavy financial losses for insurers as appropriate care is provided and paid for.

For the marketplaces to be stable and competitive, there needs to be broader participation - that is, from plenty of younger, healthier folks. From an insurer's perspective, that means developing insurance products that offer better value for consumers than simply going without coverage.

Aligning incentives
Payers, providers and patients must come together to realign the economic incentives that govern how the health care system works. For much of the last several decades, health care has operated as a fee-for-service system in which doctors and hospitals were paid more if they provided more services, regardless of whether those services led to better health results for patients. This has caused the cost of care to spiral out of control, while not significantly improving Americans' health.

Instead, our system has recognized the need to shift to alternative payment models - also known as fee-for-value reimbursement - in which providers, rather than being encouraged to pile on services, are incentivized to provide higher quality care with better outcomes while controlling costs.

Reduce waste
According to some estimates, overuse makes up from 10 to 30% of total U.S. health care spending. The high end of the range equates to roughly $1 trillion in money unnecessary expenditures.

There are numerous reasons for waste, among them that health care for patients is often not well coordinated between providers to avoid duplication of services.

Health care leaders should invest in data infrastructure that will allow for greater interoperability and more seamless information transfer between different parts of the health care system. For example, linking electronic health records and having them "talk" to one another will help us understand individual patients' journeys through the system, and potentially avoid duplicative care that could do more harm than good.

Leverage technology to make health care more consumer-friendly
A friend once said that if banking were like health care, customers, rather than going an ATM, would have to go to the bank vice president to draw a few dollars from their accounts.

The moral is this: certain types of technological innovation, such as telehealth and other types of virtual care, can make care much more convenient for patients and broaden access. In addition to making care more consumer-friendly, technology can make care more cost-effective while not compromising quality.

The Internet of things, including wearable devices and other connected consumer technology, can also generate huge amounts of patient data. If we as an industry know which signals to listen for and how to analyze them, the insights will help providers monitor their patients' conditions outside of the traditional medical environment. This could allow providers to more closely personalize care and direct them to intervene if necessary to avoid potentially costly complications before they develop.

Of all the positive consequences of the ACA, probably the most fundamental is that it gave a much-needed urgency to the cause of health reform. Following on the heels of ACA, for example, were additional laws like the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which is creating a new framework for physician reimbursement that emphasizes quality, not volume.

For me, in a very real sense, it all started in 2003, when I met the man who would change my life. I had first heard then-State Sen. Obama's name from a fellow neurosurgeon, who mentioned the candidate to me as I was scrubbing in for a surgery. I met him at a small fundraiser - many of his were small back then - and immediately saw the future president's conviction for making this a better country with more opportunity for all. Those are the same ideals for which I served the country in the military, both in and out of war zones.

So I got involved. Now, as I did then, I continue to believe in the president's vision of a more equitable, sustainable, accessible health care system. As a company, Health Care Service Corporation will continue to support efforts to expand access to quality health care in the areas we serve.