Friday, October 5, 2012

Politics and Health Reform

On October 4, 2012, Politico hosted a conversation about the role and future of accountable care organizations and their effect on providers and patients. Guests included former CMS Administrator Don Berwick, America's Health Insurance Plans (AHIP) President and CEO Karen Ignagni, Bruce Fried of SNR Denton, Premier VP Joseph Damore, and Robert Laszewski of Health Policy and Strategy Associates (see video below).

"It’s a great law, complex and complicated... but there is a continuing job to communicate how it works," Don Berwick said. He went on to state his views on health reform and some of the political implications.

"The Affordable Care Act is a great step in America towards making health care a human right in our country where if you’re an American you can get healthcare, which isn’t true now, lots of people are left out of the system, people have to worry they’re going to lose their insurance if they get sick, or if they have a preexisting condition, they can’t find insurance," said Berwick.

"The Affordable Care Act overcomes that: it says, ‘No, if you’re an American you can have health care. We’ll find one way or another,’ in partnership with the private sector to make sure that you get the health care that you need,” he said. "That’s a very important step."

Berwick claimed, and other experts on the panel agreed, that the accountable care organizations (ACOs) being promoted by the health law would continue regardless of who wins the presidential election. "Both sides endorse ACOs because it’s a good policy," Berwick said.

Health plans and large employers have tried for some time to direct patients to preferred providers as a way to control costs. This has become even more important as mounting evidence shows that high costs do not necessarily signal high quality. HMOs directed patients to particular providers by using closed networks in the mid-1990s. Robert Laszewski, who is also a former insurance executive, said there is bipartisan support for ACOs because they don’t limit patient choice of doctors like the HMOs of the 90s did. But he warned that ACOs may not save fast enough to adequately control the rising costs of Medicare. "We don’t have lots of time," he said.

Karen Ignagni, president of AHIP, also dismissed the political implications of ACOs. "I don’t think it has anything to do with the political dynamic," Ignagni said. “It has everything to do with what employers are telling health plans and their providers. They can’t afford it."



Even before the federal government launched its accountable care organization programs, ACO-style payment arrangements already had been adopted by private payers. Value-based provider networks are an attempt to help consumers make informed decisions about their care, while still maintaining their ability to choose a provider. I believe that the efforts in moving to a system that pays for value rather than volume underway in the private market will continue whatever happens politically.

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