An Election on Health Care and Costs

The recently concluded election was seen by many as a referendum on the 2010 Affordable Care Act, now widely known and even embraced by the president as Obamacare. President Obama’s re-election ensures that the implementation of reform will continue, but how a divided Congress deals with it while trying to control federal spending will remain an open question for some time.

On election night, CNN reported on exit polls showing an electorate very divided on Obamacare.  Swing states went mostly for repeal while the most populous states were solidly for expansion.

Exit polls in Ohio show 52% said they think the president's health care reform law should be repealed completely or in part while 42% said it should be expanded or left as is … Iowa: 53% for change or repeal and 38% for leaving it or expanding it. New Hampshire: 50% for change or repeal and 47% for leaving it.  Colorado: 55 - 37% for change or repeal.

However, a majority of voters in some of the country's most populous states said they are in favor of keeping the health care reform law as it is or expanding it rather than repealing or changing it.  Those states are California (50 - 42% split in favor of expansion), New Jersey (58 - 36%), New York (53 - 45%), Pennsylvania (51 - 46%) and Wisconsin (49 - 46%).

So, how will a bitterly fractured Congress representing a country starkly divided on health care control costs in an effort to reign in federal spending? Modern Healthcare shared some industry leader’s perspectives:

Dr. Jeremy Lazarus, president, American Medical Association: “It is time to transition to a plan that will move Medicare away from this broken physician payment system and toward a Medicare program that rewards physicians for providing well-coordinated, efficient, high-quality patient care while reducing healthcare costs."

John Fraser, president and CEO, Methodist Health System, Omaha, Neb.: "The change itself would’ve happened regardless (of who won). … I don’t know about certainty, but at least there’s reliability and some predictability to evolve from a volume-based system of care to one that is value-based. It really doesn’t change our plan. We wanted to develop our accountable care structure regardless of who got elected.”

Stuart Guterman, vice president and executive director, the Commonwealth Fund's Commission on a High Performance Health System:  “…The ACA provides some of the tools to address some of the big problems the healthcare sector faces. The challenge is still figuring out how to use those tools to improve the system and control costs. … The bottom line is there will be arguments about the scale of Medicare and Medicaid and how they should be financed.”

Among health care thought leaders, there is a fairly consistent focus on the need to use the tools in Obamacare to control health care costs by shifting from volume-based to value-based care—from an illness system to a wellness system. To that end, CMS reported in September that $7.4 billion in incentive payments had, at that point, been made to “more than 307,000 eligible professionals, eligible hospitals, and critical access hospitals … registered in the Medicare and Medicaid EHR Incentive Programs.” The qualitative shift from managing health instead of sickness will be supported by the ARRA investment in EHR technology.

Modern Healthcare also reported that the HIT Policy Committee met post election to push forward on the definition of Stage 3 Meaningful Use. According to William Bria, president of the Association of Medical Directors of Information Systems, the die has been cast.

“This is a permanent transformation in healthcare… We're not there yet,” he said, but “you're approaching the time when, sea to shining sea, you can do it. It's the delivery on the 'information anywhere' vision.” The election results also mean that the country will “stay the course” on healthcare payment reform, Bria said. Technology will be an important tool to the “rebalancing of healthcare delivery, and that includes payment. What we need is the pressure of politics in the next four years, and it is going to be on cost containment.”

Transformation requires Health IT and a shift in the payment model. Meaningful Use has launched an ongoing investment in the use of clinical tools required for providers to shift to a value-based health care system.  Now to address cost control, Meaningful Use incentives must be replaced by even more compelling value-based reimbursement incentives.

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