Thursday, January 26, 2012

Is Healthcare Reform Necessary?

Joe Ross, president and CEO
of Meritus Health
     Healthcare reform is a hot topic, but not so easy to understand. What does reform mean, and why should we care? Joe Ross, president and CEO of Meritus Health, draws on his years of healthcare experience and breaks the topic down in a way most people can comprehend. Here are highlights of his recent comments.

The need for change. In a broad sense, healthcare reform expands coverage, controls healthcare costs, and improves healthcare delivery. The federal deficit, aging baby boomers, the economy, and the rising cost of healthcare all drove the need for change. Many Americans rely on employers for healthcare coverage. In Maryland, close to 17% of workers are uninsured because they can’t find affordable healthcare or their employers can’t afford to offer healthcare.

More people covered. The new law expands the standard of eligibility for Medicaid, and lets parents with private insurance keep their children on their plans until the child reaches age 25. Health insurance exchanges—a marketplace for people seeking private insurance—will be available to people who don’t have insurance, small employers, and those who don’t qualify for Medicare or Medicaid. And, any insurance offered to people inside a health insurance exchange will have to cover pre-existing conditions.

Cost controls. Rising healthcare costs have long been the “elephant in the room.” Healthcare reform will control costs by moving from payments based on services, to payments based on quality—and by bundling services. Some physicians and hospitals will partner to give patients coordinated care with the goal of avoiding unnecessary or duplicate tests and procedures. The healthcare consumer will also hear the words prevention and early detection more often.

Patient Data. Hospitals and physician offices will also receive incentives to implement better data systems. These systems will help providers track and understand what’s going on with patients. For example, there are known predictors for hospital readmissions. If patients don’t see their doctors within the first three days of leaving the hospital, they have a higher chance of returning to the hospital.

     According to the Kaiser Family Foundation (an independent healthcare research and analysis organization), the United States spends 52% more per person than the next most costly nation, Norway. The rising cost of healthcare and the nearly 50 million people without health insurance can no longer be avoided. Healthcare reform is not a perfect solution, but it begins a process of necessary change. And that means we’re finally doing something about the elephant in the room.

By Anne Gill

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