Managed Care
Disease
Management

Challenges of Health Reform Are Delayed, Not Postponed

MANAGED CARE September 2013. © MediMedia USA
Editor's Memo

Challenges of Health Reform Are Delayed, Not Postponed

John Marcille

Reality might have been delayed for a year, but let’s not kid ourselves. The Affordable Care Act is law even though implementation of some elements has been pushed back. Health insurers, like everybody else in the country, face a somewhat uncertain future.

That doesn’t mean you can’t prepare for the inevitable. In fact, as our cover story by Senior Contributing Editor Timothy Kelley points out, there are nine areas demanding attention: Do more for less, deploy narrow provider networks, master new benefit designs, integrate data, learn to align with providers, consider clinicians’ morale, embrace personalized medicine, create a culture of coverage, and keep learning.

We’re learning, all right. Let’s look at No. 1 — do more for less. Peter Boland, PhD, a member of Managed Care’s Editorial Advisory Board, explains that “the only way plans will make margins is to be a whole lot smarter and efficient about how they deliver care.” See how simple it is?

Or No. 6 — consider clinicians’ morale. Physician/insurer friction has been with managed care from the beginning. But the shortage of primary care providers at a time when demand will increase means that plans will have to create payment models that make the work more satisfying.

“Many medical homes around the country have achieved results just on the backs of making the clinicians work harder,” says Paul Sherman, MD, executive medical director of the Health Plan Division of Group Health Cooperative. “They’re all burning out, and that isn’t a long-term recipe for success.”

Remember also that change will be constant. “Like any other landmark legislation, it will continue to need lots of fixes and tweaks,” says Sherman.

We will do our best to keep track.