In case you missed this week’s excellent Health Wonk Review, be sure to head over to Managed Care Matters for a little weekend reading. Joe Paduda has put together a great collection of health policy articles. Healthcare reform has been heavily partisan for the last several years (decades, really – remember the Clintons’ efforts to reform our healthcare system in the 90s?), and this year’s candidates are still sparring heavily over Medicaid expansion, pre-2014 policy cancellations, and various other aspects of reform.
But in a sign that perhaps healthcare reform is starting to become accepted as part of the basic fabric of our lives, the majority of the articles in this edition of the Health Wonk Review pertain to health policy issues that aren’t directly focused on the ACA. Although the healthcare reform law has dominated much of the health policy conversation over the last five or six years, there are plenty of other issues that deserve our attention too. And although I know that the ACA is still a contentious topic, it’s nice to see it becoming a little less so than it was even at the start of this year.
A post I wrote for HealthInsurance.org is includes in this edition of the HWR. One of the topics that is still being used as political ammunition – particularly here in Colorado’s hard-fought Senate race – is policy cancellations for pre-2014 plans that aren’t grandfathered. But in 35 states (including Colorado), regulators have allowed carriers to renew those policies again this fall. In those states, it’s up to the carrier to decide whether to renew them, and then of course the insured has a choice of whether or not to keep the plan. So although there will be some policy cancellations this fall, it’s not going to be a huge number of plans. And in many cases, the insureds will be better off with their new plan – their coverage will be more comprehensive, and if their income doesn’t exceed 400% of poverty level ($95,400 for a family of four), there are subsidies available to lower the cost of the new plans.
And I particularly liked Suzanne Delbanco’s article on Health Affairs, about how our healthcare payment system is being reformed – rather rapidly it appears. The traditional model for payment has been fee-for-service, which meant that providers were reimbursed for each procedure they did, regardless of patient outcome or quality of care. Recently – especially as a result of the ACA – there has been much more focus on value-oriented payment structures, where value for payers and quality of care for patients are both maximized as much as possible. Last year, 11% of payments to providers went through some type of value-oriented payment structure. That figured rose to 40% this year – an impressive gain for sure. It really makes little sense to pay providers for each service they provide without taking outcomes and quality into consideration. The fee-for-service model seems obviously biased towards over-utilization, which we know is one of the driving factors behind the rapid escalation we’ve seen in healthcare costs over the last few decades. Incorporating a value-based payment structure (and there are many from which to choose) seems like a fix that is long overdue.