AtlanticLIVE Health Care Forum: Building a Better Health Care System
As the health care landscape evolves and the implementation of the Affordable Care Act progresses, many wonder what lies ahead for the health care system in the United States. Recently, The Atlantic brought together leaders from medicine, public health and finance for the AtlanticLIVE Health Care Forum to discuss issues related to health law and obstacles facing health care reform. Experts on the “Building a Better Health Care System” panel addressed current challenges to the health care system and possible solutions, the progress the Affordable Care Act is making to reform the system and the influence of emerging health IT.
Steve Clemons of The Atlantic served as panel moderator. Clemons is the Washington editor at large for The Atlantic and editor of AtlanticLIVE, where he writes about politics and foreign affairs. He is also a senior fellow and the founder of the American Strategy Program at the New America Foundation.
Dr. James L. Madara is the current CEO and executive vice president of the American Medical Association (AMA) as well as an adjunct professor of pathology at the Northwestern University Feinberg School of Medicine. Dr. Madara has garnered national and international accolades for his more than 200 original publications and was named one of the nation’s most influential physician executives by Modern Healthcare.
Dr. Sam Nussbaum is the executive vice president and chief medical officer of WellPoint, Inc. He oversees WellPoint’s public health policy programs, corporate medical and pharmacy policy and clinical quality programs. Dr. Nussbaum works to improve patient care through collaboration with industry leaders, physicians, hospitals and national policy and health care organizations.
Dr. Kavita Patel is a Merkin fellow for finance reform and clinical leadership, managing director for clinical transformation and delivery at the Engelberg Center for Health Care Reform and senior fellow in economic studies at the Brookings Institution. She was a senior advisor to President Barack Obama as the former director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. In this role, Dr. Patel was critical to the policy development and evaluation initiatives related to health care reform.
The panelists discussed a range of critical issues. Here’s a look at the main highlights.
Challenges Facing the Current Health Care System
- The health care system must shift from a focus on acute disease treatment and instead emphasize chronic disease prevention. One way health organizations can facilitate this shift is by partnering with community organizations to engage in health and wellness programs. Dr. Madara highlighted the AMA’s partnership with the YMCA on diabetes prevention programs as an example, noting the community organization has a reach beyond medical facilities that is well suited to health and wellness programs.
- Professional readiness of medical students is determined predominantly by time spent in school rather than through measures of competency, which may inhibit new physicians from becoming adequately prepared to treat common diseases. A shift to competency-based evaluations is needed.
We need to align payment models with value … moving from a model and approach that pays for services to one that pays for outcomes [and] better health. – Dr. Sam Nussbaum
The Affordable Care Act
- “[An] important area that’s happened since the ACA has been the development of … care coordinators, care navigators [and] community health workers,” Dr. Patel noted, adding “You really shouldn’t use doctors like me to try to chase after patients and understand their behaviors. You should use people who understand the communities that people live in as well as the behavior patterns.”
- Additionally, the increasing demand for these types of positions can stimulate the economy and bolster the structure of the health care system by integrating service providers who support community health outside of the medical setting.
- Since enrollment opened, insurance providers report individuals of all ages and disease states have enrolled — many are believed to be new to the health care system.
- Big data can help eliminate practices that are wasteful, of poor quality or not scientifically proven in order to create funds that can be invested in innovation for the future.
- While electronic medical records have made improvements to certain health systems, the technology is still evolving to best serve patient needs and help guide practitioner care. For example, Dr. Nussbaum discussed how WellPoint is “taking our immense amount of data and actually delivering it at the point of care” to alert providers to potential gaps in patient care such as medication interaction or preventive services during the patient-provider interaction.
You really shouldn’t use doctors like me to try to chase after patients and understand their behaviors. You should use people who understand the communities that people live in as well as the behavior patterns. – Dr. Kavita Patel
A few final thoughts from the panelists:
- While access to health care and insurance has increased along with the implementation of the Affordable Care Act, Dr. Patel cautioned that it is important to recognize the gaps in access that still remain, particularly among undocumented workers and immigrant populations.
- Health technology continues to evolve and has the potential to make health care delivery more efficient and accessible for patients through innovations ranging from telehealth to “smart systems” for monitoring glucose levels at home and delivering diabetes management messages via smartphones.
All the panelists agreed that the health care system is unsustainable in its current state, but the implementation of the Affordable Care Act and advances in health IT are moving health care forward in important ways. Public health professionals such as MHA@GW students and alumni will play an integral role in the shift toward a more technologically advanced health care system that is focused on prevention. Dr. Nussbaum pointed out, “Four billion people in the world don’t have access to health care through physicians, but they do have iPhones.” While such access is an exciting opportunity to improve the public’s health, questions still remain on issues such as equal access, cost effectiveness and health literacy concerns.