A funny thing happened on the way to Obamacare: It started working, as intended–but in behind-the-scenes ways that most people haven’t heard about. Drowned out by Republican intransigence, hatred for anything Obama, and hyperventilation about the glitchy rollout, a fundamental change in the way health care [not insurance] is delivered has begun to gain traction, precisely because of certain provisions of the Affordable Care Act.
What’s happening? The Affordable Care Act’s second goal is to promote reforms to our overpriced, under-performing health care system. And now, three years after the law passed, the provisions already in effect are helping us move toward accomplishing that goal. The funny part is that, while Republican continue to wail about the [false] “government takeover” of healthcare, this change is happening in a private industry because of market pressures.
In a New York Times article, Bill Keller details what has happened–and it’s good news for patients.
Using mainly the marketplace clout of Medicare and some seed money, the new law has spurred innovation and efficiency. And while those new insurance exchanges that are now lurching into business will touch roughly 1 in 10 Americans (the rest of us are already covered by private employer plans or by government programs like Medicare), these systemic reforms potentially touch every patient, every taxpayer.
Since the Affordable Care Act was signed three years ago, more than 370 innovative medical practices, called accountable care organizations, have sprung up across the country, with 150 more in the works. At these centers, Medicare or private insurers reward doctors financially when their patients require fewer hospital stays, emergency room visits and surgeries — exactly the opposite of what doctors have traditionally been paid to do. The more money the organization saves, the more money its participating providers share. And the best way to save costs (which is, happily, also the best way to keep patients alive) is to catch problems before they explode into emergencies.
Thus the accountable care organizations have become the Silicon Valley of preventive care, laboratories of invention driven by the entrepreneurial energy of start-ups.
These organizations have invested heavily in information technology so they can crunch patient records to identify those most at risk, those who are overdue for checkups, those who have not been filling their prescriptions and presumably have not been taking their meds. They then deploy new medical SWAT teams — including not just doctors but health coaches, care coordinators, nurse practitioners — to intervene and encourage patients to live healthier lives.
Advocates of these reforms like to say that they are transforming medicine from the treatment of disease to the treatment of patients — and ultimately the treatment of populations.
Want specific examples? Here are some:
At Cornerstone Health Care, a 250-doctor organization in North Carolina, patients with a history of congestive heart failure get a daily phone call from a nurse asking them to step on a scale and report their weight, the best early indicator of an impending emergency. The next stage, Grace Terrell, the president of Cornerstone, told me, will be to give these patients scales that automatically transmit their weight directly to the nurse. (“If the N.S.A. is Big Brother, we’re Big Mother,” Terrell says of the weight surveillance program.) Diabetes patients are invited in for low-cost pedicures. Why? Because diabetics are notoriously vulnerable to infections that lead to amputation, and a common cause of those infections is ingrown toenails. (Both of these practices were pioneered by CareMore, a California-based company that runs clinics for Medicare patients and that has become a major role model since Obamacare.)
The Heritage Provider Network, a huge accountable care organization in California, offers Medicare patients free dance lessons, healthy cooking classes and casino excursions that feature “brain power” activities on the bus. The Greater Buffalo United Accountable Healthcare Network, a new, seven-doctor practice in upstate New York, is building a gym and a teaching kitchen for its patients, who are mostly inner-city minorities.
Obamacare has also had some important indirect consequences.
According to Catherine Dower of the Center for the Health Professions at the University of California at San Francisco, since the Affordable Care Act states have become more aggressive about challenging some of the protectionist laws that prevent well-qualified medical professionals — pharmacists, nurse practitioners, physician assistants, emergency medical technicians — from offering some kinds of primary care. California just passed a law that will allow pharmacists to check your blood pressure and cholesterol level and to dispense prescription birth control and antismoking drugs. Letting pharmacists perform services that don’t require seven years of medical training makes those services cheaper and more convenient, increasing the chances consumers will take better care of themselves.
But if it’s so good, why do Republicans still oppose it? Keller puts it this way:
What Obamacare has wrought is the kind of market-driven reformation that Republicans pretend to believe in. Which makes you wonder how much of their opposition rests on the merits, and how much is just a loathing for anything associated with Barack Obama.