Health Care Reform 101: What Happened and What’s Next?
Healthcare in the United States is undergoing a monumental transition. Last June, the U.S. Supreme Court upheld key components of the Patient Protection and Affordable Care Act (PPACA) in a landmark ruling that will have profound implications for healthcare IT.
In the wake of that decision, health-related enterprises now have to sort through a labyrinth of changes to reach the ultimate goal of providing better care to citizens. Here’s a look at how healthcare IT fits into the new, complex maze of regulations, and where we are headed.
Few argue with the viewpoint that the healthcare system in the United States is badly broken and needs to be fixed. For example, about $750 billion in health spending is wasted each year, according to a Sept. 2012 report by the Institute of Medicine of the National Academies. And a June 2012 study by the Centers for Disease Control and Prevention reported that 46.3 million Americans do not have health insurance coverage, a 20 percent increase in the uninsured from 1999.
The American Recovery and Reinvestment Act of 2009 contained funding for improved healthcare IT to serve as a foundation for health system reform, and PPACA was enacted in 2010 with the promise of providing affordable healthcare to a greater number of citizens, most notably the previously uninsured.
The bulk of healthcare reform legislation consists of mandates intended to change the way payers operate. Other reforms target healthcare delivery sectors such as physicians and hospitals by means such as increasing accountability and facilitating the implementation of health information exchanges.
While difficult, the move from paper-based to electronic health records will usher in an exciting new era of healthcare IT, said Dr. Robert Wah, vice president and chief medical officer of CSC’s North American Public Sector, in a recent online CSC Town Hall. “CSC’s role in health system reform is that we are using technology to deliver better information to help everyone make better decisions,” Wah explained. “Once we have patient information in digital, interoperable and connected formats, there is going to be a huge push to analyze that data in ways we have never done before. There will be powerful analytics that can be applied to this new, digital, networked information.”
This will result in much more personalized medicine, he said. “Once we have the ability to analyze this information, we will have a much richer source [from which] to make treatment decisions and recommendations. It will make the healthcare system more effective and more efficient,” Wah said.
As healthcare organizations across the U.S. waited for the Supreme Court ruling, much of the momentum gained from the early reform initiatives was lost, says Jordan Battani, managing director of CSC’s Global Institute for Emerging Healthcare Practices.
But now, “the momentum is picking up again on all of the payer sector reforms,” she says. Those reforms include programs to build state health insurance exchanges and to develop connectivity between Medicare and Medicaid programs and those exchanges.
Health insurance exchanges are automated online marketplaces where individuals and small businesses can compare and contrast different kinds of health-coverage options and make purchasing decisions. “It’s a very big expansion of online functionality and consumer-centric purchasing capabilities in health insurance, which is a relatively new phenomenon,” Battani says.
Battani says CSC is involved in many of these exchanges, most prominently in helping the state of New York build its health insurance exchange. “CSC has a number of solutions that are targeted at private sector payers in helping them build and deploy the capability to use the health insurance exchanges as a sales channel for their products,” she says.
As healthcare reform progresses, a large number of new Medicare and Medicaid participants are expected to come into the system. “One component of CSC’s healthcare portfolio is to
automate and create self-service venues for things such as appointment scheduling and wellness programs,” Battani says.
Annual expenditures on health in the United States are estimated to be around $2.6 trillion, or $8,402 per person, and another reform goal is to bring down healthcare’s astronomical costs. Battani says, “The traditional capabilities CSC brings to market, such as automation, infrastructure and business process services and outsourcing, along with our next-generation cloud and cybersecurity solutions, are the kinds of ‘nuts and bolts’ that are all very effective tools for reducing the administrative component of healthcare-cost inflation.”
Another key piece of the healthcare reform puzzle is payment reform, an effort to tie payments to efficacy and outcomes using quality indicators and outcome measurements. “We are working very closely with our health delivery clients to anticipate, reengineer and support with technology the new clinical practice patterns and administrative processes that are required to succeed under these new mandates,” Battani says.
Wah, a practicing physician and surgeon, observes that medical professionals are concerned about having to comply with each of a multitude of government incentive programs that have emerged in the past 10 years, including Meaningful Use, electronic prescribing (eRx) and the Physician Quality Reporting System (PQRS).
The programs are independent of one another and have different deadlines and penalties, and Wah says doctors are experiencing difficulty in synching up all of them. He says a positive trend is that the U.S. Department of Health and Human Services is seeking a way to harmonize all these programs, and a possible solution is to provide a one-stop application process for all of them.
Healthcare as a service
As the healthcare landscape evolves, where are we headed? Wah says healthcare, like other industries, is moving to delivery “as a service.” He sees an intersection of health IT, cloud computing and cybersecurity with the patient at the center. Wah predicts there will be a virtual platform of healthcare
data that serves as a secure pool of information. All involved in healthcare are going to be contributing data to and extracting from that pool.
“It’s pretty complicated, so the role of integrators will be important because people are going to need someone to orchestrate everything and get it done right,” Wah says. He thinks the successful implementation of healthcare reform and technology will require integrators such as CSC, which have specific expertise in government, commercial and global healthcare and
can draw from their experiences with other industries that have faced and solved similar problems before.
Jim Battey is a writer for CSC’s digital marketing team.