Reform's Bright Side: You Get to Reinvent How Care is Delivered

Philip Betbeze, November 12, 2010

You've got a lot of re-engineering to do. The Patient Protection and Affordable Care Act promises nothing less than a tectonic shift in the way your organization is paid and otherwise incented, whether you lead a health plan, physician practice, hospital, or health system. It's not hyperbole to say that survival is on the line for many such organizations.

Meanwhile, you get to soldier on under a highly regulated current system that essentially pays you per unit of service, with precious little of the equation connected to quality. Your payer mix is getting ready to change, and not for the better it appears, in many cases.

One only needs to look at the Massachusetts experiment with near-universal healthcare for a road map as to how things can go wrong when such a large number of people instantly get health insurance and overrun an already taxed primary care system. And oh yeah, that state's insurance exchange, meant to manage the risk of bringing so many uninsured under the umbrella, is hemorrhaging money, thanks mainly to political cowardice relating to penalties for not meeting the individual insurance coverage mandate.

Bricks and mortar expansion to meet this expected new patient demand, depending on what form it takes, is expensive, and it takes years to come online from the planning stage to construction. Meanwhile, more attention will be paid—and less money, too—for outcomes that don't reach or surpass some minimum standards, many of which are yet to be written.

And on top of all that, 20 million people will still be uninsured in this country (mainly illegal immigrants and a few other small groups) even when the major insurance provisions in PPACA go into effect. Of course, that group's lack of insurance doesn't mean you don't have to incur the expense of treating them, like always.

But despite all these storm clouds on the horizon, there is a silver lining. Healthcare is about to find out, as so many other industries have, that offering a quality product or service at a competitive cost means your services will always be in demand, and that eventually, you'll be paid fairly for them.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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