With a little more than 18 months since the rollout in October 2013, the adoption of health insurance – spurred by the ACA – grown by leaps and bounds, enrolling more than 11 million people in the two open enrollment periods. Amid this, the quality of care is an area that has been a mixed bag. Below, we list down 5 areas where ACA efforts have made a difference to the quality of care.
1) Increasing Focus on Prevention – Before the ACA, the American public focused on reactive care – using emergency rooms to treat illnesses, etc instead of visiting a doctor. As the ACA focuses on preventative care, this reactive approach is changing. For instance, workplace wellness programs are moving employees toward a healthier lifestyle. Similarly, preventive screening measures are covered under the cost sharing statute of the law, which has encouraged people to get diagnostic tests, thus increasing the chance of a timely diagnosis and effective treatment.
2) Renewed Use of EHRs – With financial incentives and improved technology, the ACA has encouraged hospitals and doctors to renew the use of Electronic Health Records. EHRs have increased efficiency and have improved coordinated care, especially for people who have a medical history that affects their future diagnosis. The increasing penetration of health insurance technology in the purchase and use of health insurance has connected the aspect of care to these electronic records. Over time, the use of EHRs is expected to reduce unnecessary diagnostic tests, increase treatment efficiency, and improve quality of care while saving costs.
3) Reformed Payment Mechanisms – With Pay 4 Performance initiatives and Affordable Care Organizations, the ACA has streamlined payment collection from multiple sources in the health insurance environment. With an improved mechanism, billing for unnecessary and inappropriate services can be curbed and a coordinated payment system can simplify payments for consumers through a single, bundled payment. However, we are still some time away from realizing the full value of these reformed payment initiatives.
4) The establishment of the Patient-Centered Outcomes Research Institute (PCORI) – Under the ACA initiatives, the Patient Centered Outcomes Research Institute was established to evaluate healthcare services on the basis of efficacy and costs. Through comparative study, PCORI expected to weight new cases with the old ones and arrive at expected treatment procedures and projected costs, thus culling inappropriate and unnecessary treatments in similar cases. However, the value of PCORI hasn’t been fully realized yet so it is too early to call if the non-profit organization will be able to successfully meet its intended goals.
5) Wider Access to Care – With the ACA, a lot of people who didn’t have access to preventative care now do; either courtesy of pre-existing clause or subsidies. Almost 11 million people have enrolled for insurance in the second open enrollment. But some are struggling with plan selection issues – their preferred doctor isn’t within the plan so they have to decide to change doctors or pay costly out-of-network charges. Adding to the issues is that doctors within the narrow networks aren’t accepting new patients so finding a new doctor isn’t as easy as it sounds.