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Posts tagged ‘tim porter-o’grady’

Affordable Care Act – Short Term Pain for Long Term Gain?

TWS ACA ReportingBoth human resource professionals and healthcare providers are grappling with the immediate compliance issues associated with the Affordable Care Act, even as the rules continue to evolve.  Practitioners on both sides of this equation are also contemplating the longer term cost and management implications of the Act.   Despite, or perhaps because of all the press that the ACA receives, there is still plenty of confusion about what the Act really means for employers and healthcare providers.

In order to shed some light on how practitioners are gearing up for the ACA, I spoke with our  board member, Dr. Tim Porter O’Grady and Kronos Senior Director Jim Rowe. Tim has been involved in health care for 40 years and has held roles from staff nurse to senior executive in a variety of health care settings.  Jim Rowe is the Senior Director of Total Rewards at Kronos.  Both are deeply embroiled in the practical implications of implementing the ACA, on both the employer side as well as the healthcare delivery side of the equation.  And both agree that while there should be long term benefits for Americans in the form of more comprehensive, economical and effective healthcare, there are also plenty of short term challenges to enacting the law.

You can listen to a podcast of our discussion of the following questions at:  Tim Porter OGrady and Jim Rowe Discuss the ACA 1.20.14.

  • There has been a lot of confusion around ACA with the push back of the employer mandate to 2015. But many of the provisions of the Act are already the law.  What are some of the common misconceptions about compliance?
  • What are some of the challenges that HR leaders  are already facing with regard to complying with the ACA?
  • What are some of the challenges that the healthcare community is facing in regards to ACA compliance?
  • The ACA will effect organizations of all sizes, but it will have a significant impact on smaller businesses that may not historically have had to offer health benefits. What do you think are some of the top concerns for smaller businesses – and why?
  • How do you see growing healthcare costs impacting talent acquisition and employee retention?

 What about you?  How is your organization preparing for the ACA?

Other Relevant Posts:

The Affordable Care Act Isn’t a Benefits Change – It’s a Culture Change

Engaging Health Reform

Part Time Workers Confused by the Affordable Care Act



Engaging Health Reform

patient gurneyToday’s guest blog post is courtesy of our board member, Tim Porter-O’Grady, DM, EdD, ScD, FAAN, FACCWS.  Tim brings a deep and informed perspective to the implications of the Affordable Care Act for workers, their employers and healthcare providers.  What’s your organization doing to get ready to comply with the Act?

The Patient Protection and Affordable Care Act (PPACA) is well on its way into the fourth year of implementation. Looking past the strident political machinations, human resource leaders need to now deepen their understanding of its components and characteristics and what it actually does to improve the lives of workers and how it addresses long-standing health concerns of management. For the first time in the history of American healthcare, there is a drive to achieve real health value and ultimately to change the health status of the American population.

This focus on value economics now means that there must be increasing evidence of impact in health services.  The longstanding dependence on a tertiary care model where we wait until employees get sick and then undertake a flurry of activity to address the problem leads us to higher levels of cost and a lower capacity for a sustainable positive health outcome.  Our primary care foundations or infrastructure is not yet so well developed to a level that we can focus on preventing the conditions and circumstances that lead to our highest priced illnesses and conditions. One need only look at the overwhelming problems we are now confronting with the challenges and cost of treating an uncontrolled level of diabetes directly related to obesity and the high sugar, high fat diet in the U.S. The costs associated with treating diabetes and its co-morbidities over a lifetime far outstrip the costs associated with early addressing the practices and behaviors that lead to them.

The PPACA now emphasizes efforts that directly address health concerns and issues that can prevent the later onset of illnesses. Regular screening for high risk health issues can now be incorporated into health plans in a way that addresses both illness prevention and related costs. In addition, free preventive services are provided for potentially high risk, high cost services such as abdominal aortic aneurysm, alcohol misuse, blood pressure, cholesterol, colorectal, depression, type II diabetes, HIV screenings, diet counseling and immunizations (hepatitis, herpes, papilloma virus flu, measles, mumps, rubella, pneumonia, tetanus, diphtheria, pertussis, and varicella). In addition, free counseling is available regarding obesity, sexually-transmitted diseases, and tobacco use. Since many if not most employee related sick days are the result of these identified health problems, there is a potential for significant cost benefit for employers to assure their employees participate in these free preventive services.

Provider performance now emphasizes those activities which prevent accelerating utilization of high intensity health services and repeated admission to health services because earlier services were inadequate or ineffective. Recidivistic health care will simply not be supported or funded if it represents poor provider practices or ineffective standards of care. The PPACA now requires that providers “get it right” by assuring the application of evidence-based protocols and best practices for defined episodes of care. Besides accelerating the potential for quality care, the impact on the cost of that care of more effective provider practices will be significant.

Providers will now be incented not only by price but also by quality.  Competition between plans and providers now include measures of impact especially as it relates to comparable measures of quality of service.  Quality measures will now include clinical comparative effectiveness and user evaluation of service satisfaction. Imbedded in health reform is the intent that the system must ultimately produce a healthy population, not simply treat its ails and illnesses. In fact, the notion that admission to a hospital bed is evidence of the failure of the system to better address the health needs of the person plays out as a theme throughout the PPACA.  Beginning January 1st, 2015, physicians and other providers will begin to be paid for value not for volume. The question in this climate for the provider is not how much did I do for persons but rather did I make any difference for individuals in what together we chose to do in their best interests.  Those providers than can advance the quality of service and care at the same time as carefully managing its costs will be positioned to reap value-based rewards.

For employers and their health plans, the net aggregate value of this shift in design, delivery and outcome in the PPACA provides one of the strongest efforts to date to get at real issues of health-driven care and service. It is now time for employers who have a large stake in a healthy workforce to reinvigorate their own efforts to partner with their health plans in the pursuit of early engagement health services, primary care health interventions, and the pursuit of healthier life choices. The impact of such an effort will accrue to both healthy workers and a healthier bottom line.

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The New Script for the Work of Health in America

Our board member Dr. Tim Porter O’Grady submitted the following guest blog interpreting the radical transformation of the US healthcare system required by the Patient Protection and Affordable Care Act.  Technology can help, but the biggest changes will begin with linking process to outcomes via intelligent process design and meaningful analytics.

Now that the Supreme Court has ruled on aspects of the Patient Protection and Affordable Care Act, the healthcare system is in overdrive as it attempts to reconfigure itself within the context of the Act (PPACA). The central driver for both the formation of the act and the response of the healthcare system has been the accelerating, some would say spiraling, costs of healthcare. In 2009, the gross domestic product percentage devoted to health care was just over 17%. In 2008 it was just over 16%; in 2001 it was under 15%. Clearly, the accelerating costs of providing contemporary healthcare and its growing portion of the gross domestic product have made continuing the existing tertiary care late stage engagement model impossible to sustain. As a result of the passage of the PPACA, major recalibration of the way health services will be provided over the next two decades is underway with shifts in policy, regulation, and program design. Growing emphasis on terms such as “value” and “accountability” are shifting the focus of healthcare away from emphasis on “process and volume” toward “product and value”.

The rising public and private costs of healthcare are insupportable by governments, employers, small businesses, and individuals. At the same time, costs of health service are rising and despite high levels of spending in healthcare, measures of impact, outcome, quality as tested by quality-of-life indicators such as health status, life expectancy, and infant mortality compares dramatically unfavorably with other developed nations. While advances in clinical technology have progressed significantly in the United States, providers lag notably behind the European Community, Australia, and New Zealand in the use of electronic health information systems. On top of these realities, the average annual health insurance premium for a family hovers around $14,000, nearly 55% greater than the family costs for healthcare in 2000.

There is simply no longer any doubt that major change toward higher levels of accountability from providers and a more clearly delineated health outcome needs to be more firmly embedded in a transformed health system. As all services generally become more “user-driven”, emerging models of health service must also reflect “user” or “patient-centered” approaches to delivering service. At the same time, services must result in a net aggregate positive impact on sustainable health status of both individuals and populations. With this reality as a centerpiece for healthcare design, providers must now focus their efforts within a different context in a way that demonstrates the convergence between discernible and intentional processes and their goodness-of-fit with clearly delineated and measurable health impact and outcome.

The challenge with this shift away from process emphasis is reflected in the esteem that providers have for their own good process. Indeed, indicators and measures of productivity have historically been driven by workflow, time and motion, and physical efficiency measures. This overarching emphasis on process and productivity has done much to focus on efficiency but has had little discernible impact on effectiveness. Emerging understanding of the character of professional work and judgment-based decision-making points to the inestimable value of assessment-reflection-evaluation as a foundation for delineations of value-defined productivity. The factors that now emerge as important in professional work more emphatically advance the value of creating a goodness-of-fit between effective process and relevant outcome. Indeed, the structure of service payment in the provision of healthcare will reflect how the convergence between effort and effect demonstrates best practice. Comparative effectiveness data will now compare and contrast the variety of service settings devoted to addressing particular health concerns or the health of specific populations. It is here where the shift in the minds and efforts of providers from volume to value will be most challenging.

The historic vertically constructed and compartmentalized service infrastructure in healthcare that insulated providers within the walls of their own clinical categorization and role boundaries now must become more porous. Individual disciplines must now configure in a more intentional and enumerated interface with a community of other disciplines who play a determined and articulated role in a complex mosaic of population specific health-generating activities. Financial and service success in a value-driven equation now depends on the intensity of interface and relational effectiveness between each member of the service team and the aggregated convergence of effort they all exhibit in the achievement or advancement of particular health outcomes for given populations or services. In order to both achieve and sustain this quality and value paradigm several key dramatic systems and role changes must occur:

  1. Providers in each discipline will need to create a common understandable language which clearly elucidates their specific roles and contribution to the team’s collective effort in the individual patient experience.
  2. Organization of healthcare services now must configure around a “health script” in a way that relates to advancing the health of specific persons or populations.
  3. Provider communities must be constructed and effectively configured to work conjointly both in defining unique discipline-specific contributions and collective impact and values achieved by the convergence of mutual effort.
  4. Patient “users” must now be incorporated as members of the clinical team demonstrating their commitment and accountability for their own health and for their role in contributing to the health of the community.
  5. Measures of quality and value (including financial) will now be deeply embedded in indicators of aggregated community health and wellness sustainability.

There has not been as dramatic and broad a systems shift in health services perhaps since the introduction of Medicare. Both broad and deep changes in the configuration and payment of healthcare services will call for different delineation of clinical work, relationships, productivity, effectiveness, integration, and impact. This cycle of change is early in its dynamic and it is far too soon to determine the extent of viable change and the degree of its impact. For the cynics, it may imply nothing more than rearranging the deck chairs, and for the optimists, the achievement of meaningful and sustainable community health.

As always, reality lies somewhere in the midline between these two extremes. However, what is not sustainable is an increasing acceleration of costs for health service and a concomitant decline in health status. What results in this dramatic health system transformation will, as usual, not look anything like what is imagined at its initiation. Innovation, creativity, availability to change, and adaptation will be the usual attributes that characterize successful transformation. Re-languaging health service, recalibrating service design, and evaluating provider and programmatic impact and value will be necessary for all participants and will require evaluating effectiveness within a just-in-time frame. Never having reconfigured in process and innovated on the go, healthcare leaders will have to demonstrate new competence and capacity for network management, emergent dynamics, collective enterprise, and new financial/payment arrangements. For everyone in America we are at the “Nike moment” in health transformation and it is now time to “just do it”.