In Western New York, we are fortunate to have access to some of the best medical treatment in the country. As the president and CEO of Independent Health, I hear countless stories of how patients' lives have been saved or made better by passionate and dedicated physicians and health care providers in our community.
Unfortunately, I also hear too many stories of people having to wait weeks for an appointment with a specialist, or frustrated families trying to navigate and coordinate care for an elderly parent, or costs being a barrier to needed health services.
The Patient Protection and Affordable Care Act was enacted in March 2010 to help address the frustration many Americans have with the current health care system, with the ultimate goal of improved access, quality and affordability.
Several of the law's provisions already in effect have had a positive impact. These include extending the age limit to 26 for dependent coverage, establishing zero-dollar co-payments for preventive services, prohibiting lifetime and annual limits on essential benefits, making health insurance available to children with pre-existing conditions and helping seniors pay for prescription drugs through the Medicare Part D coverage gap.
Other positive outcomes have been an investment in establishing best-practice standards and efforts by the Center for Medicare and Medicaid Innovation to bring about innovations in provider reimbursement. Rewarding hospitals and physicians for quality outcomes, rather than volume, and encouraging adherence to evidence-based medicine will help lower the medical cost trend.
The law is a good first step for those of us who believe health coverage is something all Americans should have. Massachusetts' health reform bill, which provided the template for federal reform, has seen positive results since taking effect six years ago. A Health Affairs study appearing in the journal's February issue found 94.2 percent of the state's non-elderly (ages 19 to 64) residents reported being covered in 2010, a significant increase over the 86.6 percent estimate of 2006.
The study also reports a reduction in emergency department use, including reductions in multiple visits and visits for non-emergency conditions, reductions in inpatient hospital stays and improvements in self-reported health status among Massachusetts residents. In addition, employees there continued to view the scope of their coverage quite favorably.
There is, however, reason to be concerned because many in Massachusetts have seen a significant increase in their premiums. Health care costs in the state, as in the rest of the country, continue to grow faster than wages and inflation.
Controlling runaway health spending, a major promise of health reform legislation, remains elusive. The latest Centers for Medicare and Medicaid Services report on U.S. health care spending released in January showed the rate of growth in 2010 was more than twice the general inflation rate, as total spending climbed to $2.6 trillion. The agency projects spending will increase to $4.6 trillion annually by 2020.
The Milliman Medical Index reports health care costs for American families doubled in less than nine years (from $9,235 in 2002 to $19,393 in 2011). Milliman further projects costs will increase to $41,868 per family by 2021, representing nearly 70 percent of the projected median household income of $59,859.
The health reform law faces two major hurdles this year -- U.S. Supreme Court hearings that begin on Monday on various provisions of the law, including whether the mandated purchase of health insurance is constitutional, and the November election. (Some political analysts are calling it a "watershed election for health care.")
Whether there are changes to the law or not, the fact remains the biggest challenge to fixing our broken health care system involves finding new and innovative ways to control costs. And the most sustainable solutions will continue to occur at the local level. As a community, we must maintain our focus on increasing coverage, improving the quality of care and reducing the medical cost trend. To do this, we need to build on the foundation already being created here.
A spirit of cooperation among physicians, hospitals, employers, insurers, community organizations and other key stakeholders will help establish Western New York as a model for other regions to follow.
It is my belief that these efforts should focus on five key actions to improve quality, access and affordability of health care locally and nationally:
1.) Prevention and wellness. Address the illness burden we bring upon ourselves as a result of unhealthy behaviors. Provide individuals with the programs, services and resources to make better, more informed health choices. Engage employers to make access to health services more convenient for their employees, such as the on-site health office at the Seneca Niagara Casino. Creating a culture of health will further improve the health and vitality of the community, lower rates of preventable illness and lower the overall cost trend.
2.) Payment reform. Reward physicians and health providers for quality outcomes and encourage a patient-centered model of care to improve quality and efficiency. Serious gaps in quality need to be closed by working collaboratively to develop systems to promote accessible, continuous and coordinated patient-centric care. Participating practices in our patient-centered medical home program reduced their health care costs by almost $3 million (2009-10) while improving quality measures for acute and chronic conditions.
3.) Revitalize and grow primary care. Primary care physicians can significantly change the way care is delivered by improving the coordination of care with specialists and other health providers. This will lead to improved quality and lower costs. As an industry, we must recognize this and invest in the redesign of primary care.
4.) Greater alignment of the health system. Eliminate care that is redundant or adds no value. Implement proven clinical strategies and reduce variations in care. Prevent and manage chronic disease more effectively, which helps keep people out of the hospital in the first place.
5.) Enhance health information. Accelerate the adoption and use of health information technology and electronic medical records through organizations such as HEALTHeLINK, an unprecedented collaboration among area hospitals, health plans and physicians to safely share valuable and timely clinical information.
The complete implementation of the Affordable Care Act, as originally signed into law, may well hinge on the Supreme Court and our nation's voters. But if we continue to work collaboratively, we can further transform Western New York into a high-performing health care community. The fact remains that reform must take place, not only for our physical health, but also for the economic viability of our region and the nation.
Michael Cropp, M.D., is president and CEO of Independent Health and is a board-certified family physician. He has more than 25 years of experience practicing medicine and working as a health care executive.