The Obamacare Nobody Knows – Part 2

By David Adamson

Guarantee: If you click on a few of the links below, you’ll know more about Obamacare than 90 percent of Americans. If you read just one of the books at the end, you’ll know more than 99 percent, including most representatives in Congress.

When compared to Barack Obama, John Kennedy took the easy road when he chose to put a man on the moon as his legacy project. Reforming U.S. healthcare is infinitely more complicated.

David Adamson worked in high technology and health care. He’s the author of Walking the High Tech High Wire and The Wellness Club. He’s written hundreds of blogs on politics and fitness. Learn more about David…

Healthcare reform was a priority on Barack Obama’s agenda long before he was president. At the Democratic National Convention in 2004, he delivered an electrifying speech in which he first championed “the audacity of hope,” and warned against the false belief “the health care crisis will solve itself if we just ignore it.”

Arriving in the White House four years later, Obama had a responsibility to address soaring healthcare costs because the federal government’s share for Medicaid, Medicare, VA, and federal employee insurance accounts for more than 50 percent of total dollars paid to the system. Like we citizens, the federal government cannot afford it.

Because the federal government is the largest consumer of healthcare in the U.S., it has enormous negotiating clout. So, under the guidance of leading clinicians, insurance actuaries, healthcare policy wonks, hospital system CEOs, and other experts, Obama used his power to redirect the U.S. healthcare system.

What do you think? Take the short poll at the end of this blog.

As explained in Part I of this series, the Medicaid expansions and private insurance programs which opened healthcare access to over 20 million Americans is only part of the Affordable Care Act, which most Americans simply call Obamacare. In fact, the ACA includes 10 sections, and only two of the them pertain to expanded access. The other eight sections are designed to lower the cost by improving the quality of care for all Americans. No matter where or how you obtain healthcare in the U.S., it is now shaped by the ACA, and will be for a long time to come.

The ACA is structured to attain the Institute of Healthcare Improvement’s ambitious and worthy “Triple Aim”: 1) to improve the quality of care and patient satisfaction, 2) to improve the health of populations, and 3) to reduce the per capita cost of healthcare.

Here’s a glimpse into how Obama aligned U.S. healthcare with the Triple Aim in those eight hidden-in-plain-sight sections of the ACA. You might notice some of these when you visit your doctor:

Health Information Technology (HIT)

Nothing symbolizes the accountability expected with Obamacare more than the computer your provider has in the exam room with you (and may make you feel like your provider is paying more attention to it than you as s/he pecks away at the keys).

Dependent on information technology: The use of electronic health records adopted through Obamacare helps to speed up and increase accuracy of diagnosis and treatment.

President Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. It provided $19 billion in funds to providers serving Medicare or Medicaid patients, which is the vast majority of medical practices whether government funded or private, to adopt electronic health records. The technology push was made in anticipation of the ACA to enable the reporting of performance data that would be required from all providers and insurers.

In the exam room, EHRs help your provider do mundane tasks more quickly, like order labs, write online prescriptions to your pharmacy, or double-check if you are up-to-date on immunizations. Some EHRs even suggest a diagnosis for certain symptoms and recommend a treatment.

But another main function is to generate data to verify you are receiving high-quality care. This data shows up in various places such as the Healthcare Effectiveness and Data Information Set (HEDIS).

Prevention

Experts concur that the best way to reduce the cost of care is not to need it—by preventing a disease from developing in the first place, or intervening as early as possible when one develops.

Thus Obamacare requires insurers to provide preventive screening services, such as mammograms, colonoscopies, pap smears, and immunizations, for free or at low cost. These screenings are based on clinical evidence evaluated by the U.S. Preventative Services Task Force.

You might also get screened for depression and substance abuse because about one out of four visits to a primary care office have a mental health component. Obamacare recognizes mental health as a bona fide healthcare issue.

Prevention efforts extend to community health programs promoting smoking cessation, weight reduction, better eating, exercise, stress reduction, childhood immunizations, and fall prevention in the elderly. Obamacare also aims to improve what are known as the social determinants of health—non clinical factors that can make it impossible to live a healthy life.

Obamacare rewards your healthcare network for keeping you well, as opposed to just treating you when you’re sick. One way is through Pay for Performance (called P4P in healthcare circles). Another is through Accountable Care Organizations, a model to de-fragment care delivery through collaboration between primary care providers, specialists, and hospitals. (These integrated approaches did not originate with Obamacare, but have been tried and tested in health maintenance/managed care organizations since the 1970’s to the present. Think Kaiser Permanente.)

Quality of Care

Experts agree that high quality primary care reduces the need for costly emergency room visits and hospital admissions, therefore Obamacare includes financial incentives and punishments for quality of care.

Obamacare has been the subject of protests since it was proposed and then adopted in 2010. Protests, though, have been less vigorous than current ones against the various proposed versions of Trumpcare, which would result in increased premiums and millions of Americans without insurance.

Your provider’s organization might be a National Center for Quality Assurance (NCQA) Patient-Centered Medical Home , which has very stringent performance requirements, and uses a team approach to your primary care, as well as coordinates your care with specialists and hospitals.

If you have a chronic disease, your provider is following evidence-based clinical guidelines like these from the American Academy for Family Physicians. These guidelines are based on extensive research into what treatments have proven to be most effective. Adherence to clinical guidelines, documented in the EHR, gives you the best odds to get better or stabilize the disease.

You might be surveyed to obtain your feedback on your experience with your provider as patient satisfaction is factored into the final score your provider/plan receives, and the amount of their reimbursement.

Obamacare has already improved the health of millions of Americans and their communities, despite unrelenting efforts to sabotage it.

Obamacare has targeted preventative and quality of care.

Whatever happens to the ACA in today’s cynical, ignorant and corrupt political environment, Vice-President Biden spoke the truth when he whispered these words into Obama’s ear (and a live microphone) the day the ACA was signed into law: “This is a big fucking deal!”

It still is a big deal, a very big one. This is the last audacious hope we have to make the profit-driven U.S. healthcare system work for all of us.

P.S. If you want to delve deeper into healthcare, read these. All are written by medical doctors in accessible language. (If you have limited time or interest, get the first one.)

 

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