Health Care Happenings

As I continue to digest, read, and talk to people regarding the new healthcare reform law, the Patient Protection and Affordable Care Act (PPACA) it is evident that there exists several intended over-arching themes.

The first is that the Department of Health and Human Services (HHS) will play a very large role in both the administration and the oversight of the law. A couple of things are starting to crystallize on this front. The Office of Consumer Information and Insurance Oversight just became operational. The office is responsible for ensuring compliance with the new insurance market rules, such as the prohibitions on recissions and on pre-existing condition exclusions for children that will take effect this year. Also HHS will be key in the management of pilot programs, insurance premiums, insurance exchanges, Medicare premiums, etc. It will also play a very large role in coordinating work across key federal agencies critical to the reform eg. the CDC, NIH, FDA, and CMS to name a few.

Payment for performance will take a front seat. Throughout the new law an emphasis on “transparancy” is present. PPACA sets new standards regarding reporting about quality, patient and consumer safety, efficiency, and ties to profitability in almost every sector. Also, in implementing PPACA, there will be an increased focus and scruitiny of business practices and compliance with the new regulations.

Another central theme is that of connectivity and coordination of care and services. Some have called this the “new normal” for the healthcare delivery system. This new normal will require the connection of doctors, hospitals and ancillaries with community health centers, mental health programs, school clinics etc. to bridge gaps. Information-technologies will be the glue; and new structures and newly integrated systems of care will probably result. The linking of primary care with specialty care has long been a desired goal of our system.

Changes in insurance and access. The bill’s most immediate impact is insurance reforms intended to expand coverage while standardizing benefits to assure quality is not compromised. Regulations around risk-ratings, premiums, pre-existing conditions, and health exchanges will create this new landscape. Also the fact that the individual mandate included in the bill, will increase the ranks of the newly insured by 32 million will surely result in change and challenges.

One of the largest changes that will occur will be in the collaboration between the state and federal governments. The PPACA creates numerous responsibilities with respect to implementation and administration for the individual states. This comes at a tough time for most state governments in that many of them are coping with high unemployment, over run state budgets and declining revenues, and growing obligations. As the state and federal governments share responsibility and accountability this will be a recurrent theme in coming years.

By this coming September, many of the initial mandates will be clear and implementation underway. We here at MOAA will continue to closely watch and monitor any amended changes, the effects of implementation and other initiatives associated with this new law.