Background
Health care reform in the US dates back in the 1900s; however, recent events related to the passage of the Patient Protection and Affordable Care Act (ACA) in 2010 and the ongoing implementation of important provisions of the legislation have been critical in shaping American healthcare landscape (Alvidiez, 2015; Martin, 2015). ACA-led healthcare reform aims to “expand access to health insurance coverage, contain healthcare costs, establish and promote exchanges, widen uptake of health information technology, and enhance collaboration” (Bliss, 2013). This presentation reports on the findings of a literature review conducted to understand how the ACA-led health care reform is impacting the above components. Presentation also identifies some potential consequences of the health care reform and suggests some actionable points to fast track the reform process.
Literature Review & Synthesis
Expanding Access to Health Insurance Coverage
Health care reform in the US should focus on expanding access to health insurance coverage with the view to improving the health of Americans and enhancing the global competitiveness of the country (Bliss, 2013). ACA-led health care reform seeks to move individuals out of the vulnerable ranks of the uninsured by expanding Medicaid to everyone below 138 percent of the federal poverty level and requiring the establishment of an insurance exchange where private insurance can be sold to people without Medicaid, Medicare, or employer-based insurance (Gaffney, 2014).
Problem Noted: Although the health care reform has gained some ground in expanding access to health insurance coverage, it has nevertheless failed to eliminate uninsurance and underinsurance due to high levels of cost sharing, deductibles and coinsurance, leading to fears of how to sustain the reform process in the near future (Fried, Pintor, Gravern, & Blewett, 2014; Kingsley, 2014)
Reducing Healthcare Costs
According to Bliss (2013), the ACA-led healthcare reform is already reducing healthcare costs by:
- reducing administrative and peripheral costs
- focusing on disease prevention rather than treatment of sick patients and other people requiring healthcare interventions
- advocating for a payment approach that is based on quality of care or outcome determinants, rather than fee-for-service provided
- managing costs for all stakeholders in the healthcare industry
The ongoing healthcare reform has also reinforced the concept of Accountable Care Organizations (ACOs), which has been instrumental in containing costs by “responding to changes in reimbursement, reducing fragmented care, and focusing on improving the quality of care for defined patient populations (Wexler, Hefner, Welker, & McAlearney, 2014, p. 298).
Establishing & Promoting Insurance Exchanges
The ACA-led healthcare reform is achieving the intended outcomes in terms of establishing and promoting insurance exchanges (Bliss, 2013). Insurance exchanges are not only assisting people who cannot afford group insurance to access quality healthcare, but also assisting to protect Americans from the devastating effects of illness-related financial burden while at the same time promoting prevention (Kingsley, 2014). Problem Noted: Some Critics of the ACA-led healthcare reform argue that the reality of achieving insurance exchanges may be hard to achieve due to entrenched business interests and concerns (Lape, 2013). These conflicting interests make it difficult for relevant stakeholders in the healthcare and insurance sectors to collaborate more effectively in the provision of optimal health care (Fried et al., 2014).
Implementation of Health Information Technology
According to Bliss (2013) and Wexler et al. (2014), the ACA-led health care reform is underscoring the importance of investing in information technology (e.g., electronic medical records, electronic prescribing and messaging) so as to
- minimize administrative costs
- enhance data exchange between and among healthcare departments and institutions
- promote adherence to best practices
- promote prevention and treatment
- increase quality of care
- increase integration and coordination of care
- reduce healthcare costs
- ensure optimal treatment outcomes
Problem Noted: Some healthcare facilities and ACOs lack the needed health IT infrastructure and are hence unable to minimize administrative costs or ensure quality patient treatment outcomes (Gaffney, 2014)
Promoting Collaboration Across Fields and Sectors
Ongoing ACA-led health care reform is at its infancy stage in promoting collaboration across healthcare fields and sectors. Close collaboration could strengthen and improve the US healthcare delivery system, save considerable amounts of money, and ensure seamless delivery of care across the healthcare continuum (Bliss, 2013; Martin, 2015).
Problems Noted: Optimal outcomes in this area are yet to be achieved due to lack of understanding between various stakeholders, lack of deep understanding about the various provisions of the Act, as well as fear to embrace change (Alvidiez, 2015; Lape, 2013; Wicks & Keevil, 2014).
Potential Consequences
Potential consequences of the ongoing ACA-led healthcare reform include
- Lack of close collaboration among stakeholders in the healthcare industry
- Lack of adequate understanding on the various provisions of the Act, which in turn leads to ineffective collaboration among various stakeholders in the healthcare industry
- Incapacity by some healthcare institutions and ACOs to have the required health IT infrastructure
- Failure by the ACA-led healthcare reform to eliminate uninsurance and underinsurance as originally purposed due to high levels of cost sharing, deductibles and coinsurance
Suggested Actions
Some of the suggested actions to address the noted problems/consequences include
- Federal government to help relevant stakeholders in the healthcare industry to design and implement mutually beneficial relationships aimed at enhancing collaboration
- Federal government and other players need to invest heavily in helping stakeholders in the healthcare industry to embrace change according to the expectations of the healthcare reform and also to expand their understanding of how the healthcare market is changing
- Federal government and other players to facilitate healthcare organizations and ACOs to secure modern health IT infrastructure with the view to benefiting from the many incentives under the reformed health system
Other suggested actions include
- Federal government and states need to lower the costs of insurance sharing and invest more resources to the reform agenda with the view to creating universal healthcare for all Americans
- Individual healthcare institutions to invest more financial resources in upgrading their health IT infrastructure
- Federal government to consider providing stakeholders with free implementation workshops to spur uptake of the ACA-led healthcare reform and reduce resistance to change
Conclusion
This presentation has summarized the findings of a literature review conducted to understand how the ACA-led health care reform is impacting the discussed components (“expanding access to health insurance coverage, reducing health care costs, establishing and promoting insurance exchanges, implementing health information technology, and promoting collaboration across fields and sectors”). The presentation has also identified potential consequences of the healthcare reform and suggested some points for action. Following this exploration, it is evident that the barriers that exist include lack of adequate financial resources, lack of adequate collaboration between stakeholders, absence of comprehensive understanding of the needs and demands of the health reform program, and low uptake of health IT infrastructure. These barriers need to be addressed using the suggested actions to ensure the success of contemporary health care reform in the United States.
References
Alvidiez, J.A. (2015). Where are we with health care reform? Benefits Magazine, 52(7), 28-33.
Bliss, K. (2013). Role of advocacy in health care reform: Literature review and call to action. American journal of Health Studies, 28(2), 41-49.
Fried, B., Pintor, J.K., Graven, P., & Blewett, L.A. (2014). Implementing federal health reform in the States: Who is included and excluded and what are the characteristics? Health Services Research, 49(1), 2062-2085.
Gaffney, A.W. (2014). Beyond Obamacare: Universalism and healthcare in the twenty-first century. New Politics, 15(1), 19-25.
Kingsley, T. (2014). Diagnosing the current problems of the United States health care system requires examining the history of health reform. Kennedy School Review, 14(1), 63-69.
Lape, M. (2013). Preparing for healthcare reform: Pathways to integration. Policy & Practice, 71(5), 19-23.
Martin, E.J. (2015). Health care policy: Legislation and administration, patient protection, and affordable care act of 2010. Journal of Health & Human Services Administration, 37(4), 407-411.
Wexler, R., Hefner, J., Welker, M.J., & McAlearney, A.S. (2014). Health care reform: Possibilities & opportunities for primary care. Journal of Family Practice, 63(6), 298-304.
Wicks, A.C., & Keevil, A.A.C. (2014). When worlds collide: Medicine, business, the affordable care act, and the future of health care in the U.S. Journal of Law, Medicine, & Ethics, 42(4), 420-430.