With the results of last week’s presidential election, many people are left wondering about the future of healthcare in the U.S. While time will tell what parts of the Affordable Care Act President-Elect Trump will repeal, one thing we know for certain is that healthcare payers and providers will more carefully utilize and manage capital, resources and programs to ensure Triple Aim goals — better health, better care, and lower costs. Achieving these goals in this new situation requires a paradigm shift. Supporting processes and systems will help to facilitate the transition. Data-driven processes and open, interoperable health IT systems represent the keys to more cost effective care coordination now required in this unfolding environment. Two areas we are keeping an eye on are: Medicaid block grants and MACRA.
Medicaid Block Grants
Under President-elect Trump, we will almost certainly see the elimination of additional financial incentives for states to expand Medicaid. Instead, we anticipate the drive towards Medicaid block grants where states receive a fixed lump sum every year. These grants would increase with population growth and the overall cost of living, but not with economic conditions. This is a significant change from the current federal matching program under the ACA. In order to make Medicaid programs work under the block grant model, states will need to focus on reducing costs through data-driven care coordination and delivery system reform.
MACRA, the Medicare Access & CHIP Reauthorization Act is designed to overhaul how physicians are paid under Medicare. It also designates the use of health IT solutions to achieve value-based care. Under the Merit-Based Incentive Payment System (MIPS) portion of MACRA, an eligible provider must allow each patient to view, download or transmit their patient record within a performance period, or allow them to use an application programming interface (API) to access their record—or a combination of both. The bi-partisan law goes into effect January 1, 2017 with support from 91 percent of Congress. With the likely repeal of part or most of the ACA, MACRA may well continue to play a more important role in delivering value-based payment reform.
Value-based payment reform is generating increased support from medical health insurance payers. Aetna, UnitedHealth Group, Anthem and also the nation’s Blue Mix and Blue Shield plans are allocating vast amounts of dollars to value-based payment models like patient-centered medical homes, accountable care organizations (ACOs) and other providers concerned with quality of care rather than the quantity of treatments provided.
Accountable Care Organizations
ACOs align the financial incentives of both the provider and the payer to reduce healthcare costs. When these incentives are also linked to the attainment of quality patient outcomes, the ACO model establishes an operational framework for achieving the triple aim. While the majority of ACO growth has occurred in just the last few years, the term “Accountable Care Organization” was actually coined in 2006 by Dr. Elliott Fisher during a public meeting with the Medicare Payment Advisory Commission (MedPAC). We are confident they will continue to play and increasing and important role in the future of healthcare.
That being said, one change we may see in the Trump Administration is additional review of ACO models in order to increase their long-term efficacy. This could include revising how benchmarks are calculated and over time giving providers a larger share of the savings so they can continue to make investments. As ACOs continue to prove successful, state Medicaid agencies will continue to contract with them for the administration of their Medicaid populations.
Integrated Health Technology
Change in healthcare administration is inevitable as we move forward. During this time of transition, however, the health care industry and states will continue their initiatives to coordinate patient care between multiple providers and quickly match patient needs with available resources. Data-driven processes and integrated health technology that supports evidence-based care will play a critical role in making it all happen. With our data analytics platform, Eccovia Solutions is leading the way for health and human service organizations in meeting their care coordination needs. We are watching the developments in health and human services very closely and we will continue to provide our perspective, observations and recommendations as we move through this transition to a new healthcare regulatory environment.