Today the Centers for Medicare & Medicaid Services (CMS), a client, released its long-awaited proposed rule on accountable care organizations (ACOs)—the engine that will bring Medicare further into the value-based purchasing arena and hopefully spur payment innovation in the private sector.
A recent session at the Global Business Forum: The Business of Health Care: Defining the Future, held at the University of Miami School of Business, titled Patient-Centered Care and Accountable Care Organizations in an Era of Health Care Reform, offered a glimpse of things to come.
Panelists, including John Bigalke, Vice Chairman and U.S. National Industry Leader, Health Science and Government, Deloitte LLP; Delos M. Cosgrove, MD, President and CEO, Cleveland Clinic; Stephen K. Jones, President and CEO, Robert Wood Johnson University Hospital; Anthony Rodgers, Deputy Administrator, Center for Strategic Planning, CMS; and John M. Kirsner, Partner, Squire, Sanders & Dempsey LLP, agreed that ACOs are ushering in a new era of patient care. Among the conclusions offered by the panel:
1. Dramatic change is coming in how hospitals, physicians, and insurers will be incentivized. The focus will be on quality, not quantity. Some hospitals have already begun providing salaries for surgeons and physicians so that they receive the same pay regardless of how many patients they see. The government and insurers will begin increasing allocations for services to ACOs who have fewer patients returning to hospitals prematurely.
2. Electronic medical records (EMRs) mean better outcomes for patients. EMRs are a key tool in the movement to develop ACOs, as they allow providers to monitor patient care throughout the treatment of a condition or illness. Public and private payers are incentivizing the transfer to electronic medical records, providing hospitals and providers with funding and support to create a streamlined, consistent system.
3. Newer strategies for physician-hospital “alignment” will benefit all. First attempts during the 1990s to align physicians and hospitals failed because these were seen as purely economic plays without focusing on patient-centric outcomes. New calls for alignment are driven by reductions in fees from Medicare combined with a poor economy – universally accepted realities. Combine that with awareness that hospitals will become major aggregators and distributors of payments for services, and the increased desire of physicians to have control over their work/life balance, resulting in increased willingness to align.
These insights address some of the operational and strategic issues at play. But the impact of ACOs will be far-reaching, and the implications far-reaching.
What does it mean for stakeholders?
A sea-change in health care delivery such as the kind that is taking shape over ACOs, will require clear and consistent communications to a number of audiences. Patients, for instance, will need to understand the value of more coordinated care if they are to be willing participants in the process. Increased reimbursement—that is, paying for outcomes rather than volume—means little to consumers. What does matter, though, is their health. Both physicians and payers need to collaborate on communications that tell the ACO patient-centric value story.
Policymakers also have a role to play here. Throughout the health care reform debate, the Administration demonstrated its keen ability to take complex health policy issues and put them into language that the general public understands. That work must continue now, as stakeholders work to reform the way care is delivered. The more the government supports the movement toward better coordinated care, the more likely Americans will be to adopt ACOs and other models of care coordination. To that end, CMS’ newly-created Innovation Center must go beyond funding and establishing pilot programs to develop ACOs and other integrated care models. The Innovation Center also must educate consumers on the importance of coordinated care and how new delivery models will make our population healthier. Successful communications will require private-sector collaboration; there is an enormous opportunity for government and industry to work together to foster a dialogue among consumers on the importance of moving toward coordinated care models.
In addition to consumer communications, providers, payers, and government also must now give thought to how to more effectively communicate with one another. At times, the media has been used as a vehicle to influence tense negotiations between providers and insurers. The same may be said for government and those in the private industry. In order for ACOs to work as envisioned, old tensions and the tools used to stoke fires must be put to rest. If providers, payers, and government realize the advent of ACOs and other care coordination models are a win-win-win, they will work collaboratively toward shared outcomes that benefit both the patients and members they serve, as well as their own businesses.
As the panelists at the Global Business Forum noted, the future of heath care delivery holds great promise for a new way of treating the chronically ill. How stakeholders communicate this potential—both to their customers and among one another—will ultimately be critical to the success of these emerging models of next generation health care delivery.
David Sheon, who is a health and medical communications consultant, contributed to this post.
Jeff Smokler is a senior vice president in the health care practice of Powell Tate, a division of Weber Shandwick.
Three months after the passage of the Patient Protection and Affordable Care Act (or Health Care Reform, for short), the same high-level congressional staffers who played a major role in crafting the legislation are highly invested in its implementation.
At a CQ-Roll Call Group Policy breakfast here in D.C., several aides who were at the center of it all — Dan Elling of the House Ways and Means Subcommittee on Health, Chuck Clapton of the Senate Committee on Health Education Labor and Pension, Dr. Liz Fowler of the Senate Finance Committee and Tim Westmoreland of the House Energy and Commerce Committee and Georgetown Law — dived into the wonky details of the bill’s effects on prescription drug coverage, each state’s ability to expand Medicaid, physician reimbursements, the constitutionality of the individual mandate and more.
Disagreements over the details continue but all seem to agree on one larger issue: the implementation of health care reform will be a far greater challenge then harnessing the votes to pass it. Clapton said he’s not surprised by the entrenched opposition because without a single vote from Republicans, opposition leaders can say “I told you so” every time a provision falls short of expectations. But will the GOP soon put down its picket signs and take a seat at the table?
Fowler thinks so. With continued attention from the Obama administration, she thinks the insurance industry and others will “put their battle armor away” now that the bill is law and play a proactive role in shaping a new system that reduces costs and provides better care. Still, Fowler lamented the “striking level of misinformation” at kitchen tables around the country while Westmoreland called state Attorney General lawsuits against the individual mandate “very good PR, but not good law.”
Americans are calling for civility from politicians, the media and corporations now more than ever. With so many hands in the health care pot, it’s going to take a cohesive PR shift to make the implementation process more civil than it has been, but the consensus seems to be that we’ve got to try.
For additional insight, read HHS Secretary Kathleen Sebelius’ recent commentary in Roll Call on making PPACA implementation work.
While many are celebrating the enactment of healthcare reform as the culmination of a many-decade battle, others see it as just the beginning of a prolonged conflict. What can businesses expect in the coming months, and what are the communications implications?
1. Partisan polarization and anger will likely intensify.
Members of Congress on both sides of the aisle will be focused on scoring political points prior to the mid-term elections in November. With Republicans believing that major gains are achievable in the mid-term elections, there is little incentive for bipartisan cooperation.
Implications: It will take some time – and the election in November – to restore a level of comity to Washington. Companies should stay above the fray and avoid getting pulled into political arguments.
2. Legislative and regulatory changes have just begun.
Several state attorneys general are already challenging provisions of the law, and states will likely react with legislation and regulation of their own. Congress will soon begin the serious work of correcting “mistakes” and unintended consequences in the new law. With the government more deeply inserting itself into decision making, the opportunity for new legislative, regulatory and other political influences on the healthcare sector will grow.
Implications: Look for opportunities to shape the legislative and regulatory proposals that may proliferate — there may be emerging issues in which high-profile engagement could damage your brand, but there may also be opportunities to use visible engagement on key issues to enhance your brand.
3. Some companies will seek to get ahead of the curve.
Some companies will seek to create differentiation with competitors by getting ahead of the curve on changes required under the new law. We have seen this practice in other industries following enactment of major new regulatory requirements.
Implications: Stay alert to the activities of competitors. Develop clear messaging on your company’s commitments and intended direction — and re-examine it frequently.
4. Questions about the new law will abound.
Many of the new law’s provisions do not take effect for years. This could create uneven expectations, as well as much uncertainty and confusion.
Implication: Understand whether and how your products and policies could contribute to or ameliorate this frustration. Communicating implications of the law soon (and often) can reduce confusion.
5. Media and academic observers will start to ask, “how is it going?”
Stories and studies about the impact of reform on both consumers and businesses will shape perceptions of reform, as well as of industry players.
Implication: Be prepared to start answering the “how is it going?” question from the beginning. Start collecting information from your own business, industry and stakeholders. Look for opportunities to leverage your experiences into leadership and influence on key issues and controversies.
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