Health reform stands as justices, voters ratify Obamacare
The Obama administration’s ambitious overhaul of the nation’s healthcare system weathered some significant challenges in 2012 and came through relatively unscathed.
The first major test came in June, when the U.S. Supreme Court refused to overturn the Patient Protection and Affordable Care Act, while still ruling that the law’s provision requiring individuals to obtain health insurance was unconstitutional.
What saved the ACA was the court’s decision that the government’s mandate to purchase health insurance qualified as a tax.
The high court’s decision to uphold the individual mandate “means that some 40 million Americans identified as uninsured will be required to purchase some level of insurance in 2014,” DSN senior editor Michael Johnsen reported June 28. “That will drive a good number of patients to medical homes and in theory, significantly increase the demand for maintenance prescriptions and other preventive or chronic healthcare services.”
The ACA leaped a second big hurdle on Election Day, Nov. 6, when voters returned President Barack Obama to office for a second term. The president’s re-election turned aside a serious challenge to the law, which Republican contender Mitt Romney had vowed to oppose, and kept health reform on track for full implementation by 2014.
Retail clinics to grow as hospitals embrace community care
With health reform and health cost imperatives driving the need to find alternative, community-based ways to deliver more cost-effective follow-up care, the retail clinic model could be poised for a new round of rapid growth.
Pharmacy-based walk-in care centers offer some compelling advantages to a health system in dire need of alternatives. Amid the increasingly expensive cost of care provided by hospitals and physician groups and the growing shortage of primary care physicians, retail clinics offer patients and health plan payers accessibility, convenience and a far cheaper brand of care for routine illnesses, health screenings and first aid.
“The demand for health care is steadily growing as the population ages and increases, creating some strain on often overworked hospitals and physician practices,” noted Boehringer Ingelheim Pharmaceuticals in a report on retail clinics. Those clinics, BI noted, provide “a way of addressing this issue.”
“The number of ‘convenient care’ clinics and ‘urgent clinic’ centers is growing strongly,” noted a report issued in September by Marketdata Enterprises. “It’s likely to stay that way through 2016.” Marketdata projects the size of the retail clinic market to reach 2,700 clinics with combined revenues of $1.38 billion.
Pharmacies extend ACO movement
With new payment models beginning to change the way hospitals and health providers are reimbursed for their services, health plan payers scrambling to control unsustainable medical costs and health information technology linking up the patient care silos, a more integrated and patient-centric care model is emerging out of the chaos of a health system in transformation.
Two terms point to the changes sweeping health care: “accountability” and “integration.” Both are fueling the rise of accountable care organizations as Medicare, Medicaid and commercial payers shift from a costly fee-for-service payment system to a new, evidence-based reimbursement model based on successful patient outcomes and reduced hospital re-admissions. Making the process possible: the integration of care as hospitals, physician groups, clinics, testing labs, pharmacies and other members of the healthcare team begin to create a more holistic, patient-centered model of treatment and prevention.
The rise of evidence-based payments is spurring the creation of both hospital/community care partnerships and ACOs to build new bridges to patients, improve continuity of care and cope with the new reimbursement paradigm. Forward-thinking pharmacy operators are scrambling to adapt and stake a solid claim to the ACO model being hammered out by hospitals and regional health systems across the country.
“With payers moving toward paying for quality, … the only way to have solid quality is to protect the continuum of care,” noted Ken Berndt, CEO of Careworks Convenient Healthcare, the clinic division of Danville, Pa.-based Geisinger Health System. “If we’re going to get paid that way, you’ve got to have an ACO, and you have to have some retail [pharmacy and clinic component] for patient access.”