Don’t you love when an old product is repackaged, re-pitched and touted as “new and improved.” At WBC (wbcbaltimore), we particularly get a chuckle when it applies to healthcare. Nothing in healthcare is really new. Just dust off an old concept, slap a updated name on it and get a writer to publish an article on the “innovation.” The Affordable Care Act (“ACA”) is part of this folly, and has been presented as the wave of the future; an act so sweeping and revolutionary that the uninsured will be covered, healthcare costs will be reduced and the federal deficit will be slashed!

Of course, anyone old enough to tie their shoes should know by now that this presentation was a fantasy and impossible to achieve under the constructs of the ACA. Let’s take a look at some of the more obvious elements that are marketed as “new’, but are really just a re-hash of previously recognized strategies:

Universal Coverage: this old chestnut was discussed back in 1965 as a follow-up discussion to Medicare. Ted Kennedy and Hillary Clinton brought an updated spin to this “progressive” objective over the last 25 years. The irony related to health care costs is that, as a society, we don’t suffer from too little insurance, but rather,  too much insurance!  The third-party payment system where the utilizers of care are divorced from the payment for services has been one of the principal cost drivers of healthcare expense over the last 50 years!

Accountable Care Organizations: Sounds interesting.  Let’s provide a coordinated approach of delivering care where one team of medical providers can communicate with each other, share resources, follow best practice guidelines, work from a global budget and receive financial incentives based on quality benchmarks and improved outcomes. Sounds terrific, accept we’ve had for over 50 years!  It’s called Kaiser in most markets and certainly a re-introduction of tightly managed HMOs from the 1970’s!

Focus of Preventive Care: This certainly makes intuitive sense, i.e., lets pay for early detection, screenings and general wellness-types of programs so that participating members can avoid more costly and debilitating disease states down the road. This urban myth was begun in the late 1990’s as the only real solution to controlling escalating healthcare costs.  The problem is that there is little empirical evidence beyond anecdotal stories, that these initiatives save any money.  They are positive because health promotion is the right thing to do and generally improves the members quality of life, but to push this agenda as a big contributor to “bending the cost curve” has yet to be proven.

“Death Panels“:  OK, this nomenclature was part of the political debate in 2009 and really not identified as such in the ACA, but there is no doubt that the concept and actual practice of a bureaucratic committee that will have authority to address medical budgets and what services are “approved” is included  in this deal. It’s called the Independent Payment Advisory Board (“IPAB”) and is a panel of 15 commissioners appointed by the President who will provide guidance on Medicare-related issues. It’s not much of a stretch to see how these healthcare cost decisions are extended beyond Medicare and applied to any healthcare that receives government funding (including subsidies).  Again, an old concept made new. In the UK, its called the National Health Service and the panel there determines which medical treatments have an appropriate cost/benefit relationship. Treatment or services that fall outside the cost equation for care are not approved.

And the re-cycling of healthcare terms, concepts and programs are not just limited to the ACA. We see it throughout the industry. We predict that you will continue to see new packaging on approaches for disease management, medical homes, capitation, global budgets and more throughout the rest of this decade!

Leave a Reply

Your email address will not be published. Required fields are marked *