Affordable Care Needs To Be Accountable Care

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Another installment in the examination of healthcare through the customer experience lens from Amber Thompson and John McCabe.

Now that the Affordable Care Act (ACA) has become a reality to employers, consumers, and insurers, many are still wondering “what is the real impact to me?”  The good news is now all Americans (employed or not, sick or well) qualify for an affordable health plan as Insurers can no longer deny medical coverage based on health status.  In 2010, the U.S. Census Bureau published an article informing us that 49.8 million Americans were without health insurance. While this is an important step in achieving equality across all citizens, unilaterally providing comprehensive coverage will also help battle chronic plagues and cost drains on the system- namely using the emergency department as primary care and over-utilization of resources (diagnostics and tests, repeat admissions, frequent ER flyers).  As a result of changes forced by reform, our patient population can now be viewed more holistically. While Physicians are still focused on providing the best care possible, it is important to remember that services can now be provided to a much larger audience. With millions of consumers now eligible for insurance coverage, healthcare and ancillary service providers are faced with a new challenge- sheer volume. To avoid the old model of providing care based solely on utilization and not on quality, we need to use this opportunity to reinvent how patients are treated by the system.

One way to accomplish this goal is to provide services based on preference and convenience. If we take a page from the education industry, transformation and innovation can be driven by consumer preference, where it seems unlikely on the surface. Academic institutions have been listening to consumers.  And as a result, we now have many virtual learning options.  Many find that the virtual classroom provides easy and convenient access to higher education while providing students the same services as the traditional classroom setting.  But most importantly, the education industry created alternative options based on what consumers wanted.  And in turn, increased the amount of adult learners by 30% over the last five years.  According to a study “Going the Distance: Online Education in the United States, 2011”, more than 6.1 million students took at least one online class during the Fall of 2010.

Healthcare continues to transform delivery models.  But it’s important to remember that the patient is the most important factor in meaningful care delivery. When we provide the patient and their families’ convenient options, the ability to access Healthcare Providers in real-time to help navigate comprehensive care maps, the integrated care team model becomes much more attainable.  The Patient Centered Medical Home (PCMH) concept definitely works in bringing many providers to the patient.  But we have to make sure these options are as convenient for patients and their extended support system as they are for the Healthcare Providers.

Now that we have the ability to treat more people due to ACA, let’s make sure we take full advantage of the opportunity to drive long-term change that benefits everyone- better utilized resources (equitable consumption), reduce waste due to unnecessary tests and procedures (lower cost), and healthcare as an attractive and financially attainable career choice (create access). It’s certainly going to be a long and winding road, but it’s also an exciting time to be a part of this industry.

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