The Affordable Care Act could Decrease Chronic Disease Rates

February 11, 2016 - Needless to say, healthcare reform and the Affordable Care Act have revolutionized many avenues of the health payer industry. The individual mandate along with Medicaid expansion and federal tax subsidies on the health insurance exchanges have led to a huge surge in the number of insured individuals around the nation.

The Affordable Care Act has also stimulated healthcare reforms aimed at advancing value-based care payment systems and cutting healthcare spending across the board. However, some critics of Obamacare have questioned the constitutionality of some of its provisions. Republican presidential candidates have also proposed repealing the entire healthcare law. These implications could affect the future of the Affordable Care Act.

Prof. Prabjot (Jodie) Sandhu, MSN, FNP-C, PA-C, CNL, DNP(c), FNP-C at the University of San Francisco, spoke to HealthPayerIntelligence.com about the future of the Affordable Care Act and many of the opportunities Obamacare opened up for the healthcare industry.

HealthPayerIntelligence.com: What are some of the biggest obstacles regarding healthcare access that the Affordable Care Act has overcome?

Prof Jodie Sandhu, FNP-C: “One of the first things for increasing access to care [was developing the health insurance exchange]. Currently there are 12.7 million Americans who have selected plans through the health insurance marketplaces and more than 80% are receiving some type of subsidy to be able to do so. Having a mandate for insurance has led the American population to be qualified for healthcare at the basic level without paying private insurance rates.”

“Medicaid expansion [has also increased coverage]. Twenty-eight states have adopted policies to expand Medicaid coverage, which reaches out to an additional 13 million people. The reimbursement that can be given to hospitals and providers who take Medicaid patients, reduces the taxpayer dollars spent, when uninsured patients seek care that is not compensated for.”

“While the ACA seeks to strengthen healthcare at the primary and preventative level, another important impact has been on the funding being available to develop more structured, interdisciplinary, and collaborated community center models and establish more community centers as a whole.  With Community health centers taking care of 23 million patients annually, they are the safety net for primary care and also a vital model for holistic patient care.”

 “The Affordable Care Act has also addressed rebuilding the primary care workforce, realizing the shortage of primary care providers in this nation. This includes programs for medical students who are going to practice in primary care to receive grants, funding, scholarships as well as support to those programs which will increase the number of trained primary care health care providers, such as ‘nurse practitioners’ and ‘physician assistants.’”

“The Affordable Care Act also brings back into focus the negative impact of insurance companies to hike rates, choose their clients, and protect only themselves. Under the ACA, health insurance companies have to invest at least 80% of what the consumer pays, back to improving healthcare. Regulations to protect consumers, also include state programs in which insurance companies must provide justification for any rate increase greater than 10 percent.”

“The most basic attribute of ACA is that it provides a more universal type of healthcare coverage – making sure everyone is getting the preventative services and healthcare screenings. It is not up to insurance companies to decide which screenings and important tests to offer. The ACA provides regulations on which services are considered primary care and what needs to be offered in terms of preventative screenings across health insurance marketplaces.”

“Another obstacle that is being tackled is the restructuring of payment to providers. I think this is one of the areas in which providers are not happy with the Affordable Care Act because this is a change – a shift – in how we have worked all of these years, decades even.”

“Instead of payment for services, we are moving towards a more value-based system. It’s going to be payment based on quality and not quantity. This involves building packages for reimbursement that Medicare is accomplishing – bundled payment plans and outcome-based intervention models. The ACA is focusing on the quality of health, not the quantity of procedures and tests that providers can run to make more money, costing the economy and the consumer billions of dollars”

“There are many, many obstacles that the Affordable Care Act is hoping to overcome as the implementation continues.”

HealthPayerIntelligence.com: What can we expect for the future of the Affordable Care Act and healthcare reform?

Prof Jodie Sandhu, FNP-C: “This is the big question and this is where everyone’s patience kind of has died off. I think there are so many positives to the ACA. I am definitely aware of some of the fallbacks and issues that we are going to have. I’m very realistic to say that anytime we’re proposing a change that’s this big – anytime that we’re going to roll out a law that’s going to affect millions of people – there are going to be hurdles.”

“There are steps that we have to take to figure this all out. Healthcare reform is necessary for the condition our country is in today. The burden of chronic disease, can only be lightened by preventing the onset of certain conditions. Prevention has to be in the spotlight and we need to deliver healthcare for the purpose of keeping Americans healthy, not for the purpose of making more money. The Affordable Care does not advertise to fix the broken system in one year, or two.  It is a long term solution with many short term changes to service the recovery of our broken system.”

“I think if we look at it realistically in terms of healthcare reform over a number of years, there’s a lot of benefit. The biggest benefit from my perspective, being a provider for the last 13 years, is increasing access to care for people who have never had insurance – these are the same people that go to emergency care and urgent care centers for their care. It is still taxpayer dollar taking care of these populations.”

“Expanding healthcare access and providing free preventative care – wellness checks, the physicals, screenings, and mental healthcare – these are all mandatory obligations now under the Affordable Care Act for a basic healthcare plan to provide these things and necessary components of medical care, not an option or luxury.”

“If we can do this at a population level and start to offer more of the preventative screenings, we’re looking at the far end of the spectrum of reducing chronic disease and other health issues that ultimately cost the economy and insurance companies more.”

“There are different initiatives that the Affordable Care Act has put into place. For example, the Comprehensive Primary Care Initiative in which certain states have modeled type of health care delivery system that is able to help patients receive comprehensive care in one setting.

“By providing this comprehensive care model, providers are able to interact with patients quicker, provide different types of care and strengthen communications between providers. The Partnership for Patients Initiative is another which finds the best models and best practices to help hospitals acquire that knowledge so that we can reduce readmissions and decrease that harm risk across hospitals.”

“However, Medicare, for instance, documents and states that they’ve paid $316 billion less through the year 2013 so far, since the initiation of the Affordable Care Act due to restructuring. That included bundled payment models and value-based care modeling. Already we’re seeing healthcare reform at work in terms of decreasing cost to society and increasing the benefits to the population.”

HealthPayerIntelligence.com: In what ways has the Affordable Care Act positioned the healthcare industry to cut costs in terms of emergency and chronic care?

Prof Jodie Sandhu, FNP-C: “In terms of emergency care and chronic disease leading to increased hospitalizations.”

“The ACA increasing access to care and providing preventative services is the first step to decreasing unnecessary ER visits, and preventable long term complications.”

“With Medicaid expansion, hospitals have received $7.4 billion in compensated care benefits when compared to the years with a higher percentage of uninsured individuals.”

“The data shows that hospital acquired infections, falls, and traumas fell by 17 percent [due to the Affordable Care Act]. With the Medicare overhaul related to ACA, we are now seeing fewer hospital readmissions which come at a cost of $26 billion to Medicare.”

HealthPayerIntelligence.com: How would a repeal of the Affordable Care Act impact the healthcare industry, the patient community, and health payers?

Prof Jodie Sandhu, FNP-C:  “What we’re talking about is that there are about 13 million people who became insured after the Affordable Care Act was passed. These newly insured people are provided with medical benefits and healthcare access which they did not previously have. There’s now also a good portion of Americans insured under Medicaid.”

“By taking coverage away, there will be higher out-of-pocket costs to cover unnecessary interventions and higher rates of chronic/preventable disease. The idea of pulling insurance from 25 million people will shift the focus of healthcare back to emergency and non routine care for many Americans.”

“Repealing ACA, would mean another win for insurance companies, to deny patients coverage or provide basic services.”

“The challenges of ACA are present but not worth a repeal. Healthcare has already started to shift and adopt changes that represent a better, safe, more effective, and efficient environment for patients. We need to find the pieces of the puzzle that work and leave them alone, then figure out how to improve what may not be functional well at this time. The power of health should not belong to insurance companies or drug companies, who are the driver of medical costs and the reason that medicine has become a business. Healthcare belongs in the hands of the provider and the patient and this is what ACA aims to do.”