The ACA is Changing Healthcare

Falls Church—The Patient Protection and Affordable Care Act (ACA) has transformed the healthcare industry, leading to delivery and payment reforms. Payers are focusing more on the value of care and attempting to compensate doctors on quality measures rather than for every test and procedure. Although costs are still high and millions of Americans are not healthy, the ACA can have a positive impact, according to Eric Berman, DO, regional chief medical officer, Amerihealth Caritas Family of Companies.

“I really believe [the ACA] is a huge opportunity for us,” Dr. Berman said. “Failure is not an option.”

Dr. Berman, who spoke at the Leadership Summit on Medicaid Managed Care, used the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being,” and said that socioeconomic, environmental, and behavioral factors also influence health.

In 2009, healthcare expenditures accounted for 16.3% of the United States’ gross domestic product, more than any of the 34 countries affiliated with the Organization for Economic Cooperation and Development (OECD). However, the spending has not led to better results. Of the OECD countries in 2007, the United States ranked 25th in maternal mortality, 26th in life expectancy, 28th in low birth weight, and 31st in infant mortality, according to Dr. Berman.

In the United States, 45% of people (120 million total) have a chronic medical condition and 60 million have multiple chronic conditions, according to Dr. Berman. Approximately 70% of deaths each year in the United States are from chronic diseases, while half of all deaths are associated with heart disease, cancer, and stroke. He added that an estimated 150 million people would have a chronic condition by 2015. Furthermore, compared with other countries, such as Australia, Canada, France, Germany, Japan, and the United Kingdom, the United States has the highest health spending per capita, the highest prescription drug spending per capita, and the highest obesity rate.

Still, millions of people are not taking care of themselves, even when they are prescribed medications. Dr. Berman cited a study that found 88% of people fill their prescriptions, but only 76% take the medication and 47% continue taking the drugs in the long-term. Each year, there are an estimated 1.5 million preventable adverse events, resulting in $177 billion in injury and death, according to Dr. Berman.

“[Nonadherence] is a serious problem that is underrated,” he said.

Dr. Berman said the industry should follow the Institute for Healthcare Improvement’s Triple Aim of improving the patient experience of care and the health of populations and reducing the per capita cost of care. He added that the quality of care, access to care, and costs of care were all important to consider.

Physicians are affected by the changes and are going to have their payment structures changed in the future, according to Dr. Berman. He recommended paying doctors using a hybrid model of fee-for-service and capitation based on results and the quality of care they deliver.

“The [doctors] will do what you pay them to do,” Dr. Berman said.