Last week, the National Association of Public Hospitals and Health Systems (NAPH) celebrated its 30th anniversary and its annual meeting focused on the public hospitals’ role in a reformed health care system. Although the advent of Medicare and Medicaid in the 1960s challenged the need for these systems, today the Affordable Care Act (ACA) reinforces the historical and future role of the hospital safety net.
NAPH invited a number of national health care leaders to provide their perspective on the future. Some of their observations include:
The Public and Health Care Reform
Celinda Lake (Lake Research Partners) is one of the Democratic Party’s leading strategists and pollsters. She reviewed a number of polls regarding the ACA and provided some very interesting insights. For example:
- The country is still split on the idea of health care reform as a whole, but when individual pieces are presented, they almost all have high favorability ratings – with the exception of the individual mandate.
- Although most individuals understand some of the insurance aspects of the ACA, they clearly do not understand the system reform elements. For example, when asked if they would like to receive their care in a medical home, most individuals recoiled at the thought. “Why would I want to be put away like that?”
- Finally, 30 percent of Americans think health care reform has already been repealed. This will be an interesting challenge when the Health Insurance Exchanges begin to operate in 2014.
The States and Health Care Reform
Alan Weil, the executive director of the National Academy for State Health Policy, provided an overview of the implementation of the ACA in the states:
- All but a few states are engaged in planning for ACA implementation.
- All state budgets have Medicaid funding problems because the stimulus funding for Medicaid is gone this year – hence most states are seeing a jump of 15 percent in the cost of their programs even with stable enrollment.
- Everything at the state level is now focused on the budget – not on policy. Hence reductions in Medicaid are happening in most states regardless of the consequences because “we just don’t have the money.”
- States are encountering an unexpectedly high level of complexity as they plan their new systems due to the interactions of Medicaid and the Health Insurance Exchanges, new system of Medicaid eligibilityand benefit designs for the new program.
- Finally, more progressive states are beginning to “re-imagine” a new role for Medicaid as it becomes part of an insurance system that is integrated with private insurance and provides coverage of individuals up to 400% of the Federal Poverty Level.
Hospitals and the Health Care Reform
Richard Umbenstock, president of the American Hospital Association, presented a cautionary view of the future for the hospital industry. Even as the ACA is implemented (and modified), he felt that the future for all hospitals was fairly clear with these three key elements.
Hospitals in the future will be:
- Integrated with all of the key elements of the health care delivery system
- At risk financially through bundling, capitation and other new financing mechanisms
- Accountable through public reporting and financial transparency
Umbenstock was very skeptical of the ability of competition to improve the quality and cost of the system in this new environment.
For example, almost every health care delivery organization’s strategic plan today includes some sort of “growth” goal. Unfortunately, if you add all these plans together and they succeed, it will bankrupt the system. Therefore, his view was that the only way to achieve success in a reformed system is through collaboration – not competition. Collaboration will take many forms – doctors with hospitals, health systems with health plans, and patients with their care systems.
Our experience with our health care students at the University of St. Thomas (who are all practicing health care professionals) has taught us that collaboration is much more difficult than competition. However, with a new collaborative approach it is very possible to envision an exciting and high performing future health care system in the United States.
Safety net hospitals have historically been leaders in collaboration in their communities. Hopefully other health care organizations can learn from their example.