Will the Affordable Care Act (ACA) be repealed and replaced? Will the 19 remaining states ever decide to expand Medicaid? Could pre-existing conditions prevent people from obtaining insurance coverage? In many aspects, the future of healthcare is quite unclear – murky at best – and organizations and providers are doing what they can to make it through this period of transition.

What does the future hold for healthcare organizations, providers, and consumers?

While we do not have a crystal ball to predict the future of healthcare, it’s clear that new obstacles will become apparent and some of the current struggles will continue. Join us as we take a glimpse into the future of healthcare.

“If anybody thinks that health care is going to be fixed by the government or insurers, they’re crazy, because it’s only the providers that are going to innovate.”

Does the Future of Healthcare Include Single-Payer?

As the United States’ healthcare system continues to muddle through this period of uncertainty with the status quo, Obamacare, the issue of single-payer is brought up by legislators time and time again. Dr. Tim Johnson, an editor for ABC News, compared the single-payer healthcare system in Canada to care delivery in the U.S.

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Johnson reviewed the procedures for families at an office in Buffalo, New York and another office across the border in Ontario, Canada. The two families both had a mother who gave birth. In New York, the couple was self-employed and without health insurance. Thus, the husband spent much of the time while his wife was in labor, in the financial office sorting out the logistics of a payment plan for the hospital expenses.

On the contrast in Canada, when the couple came in for the delivery they took them right in and provided care. In the husband’s own words, the staff “whisked us upstairs”. These words stuck with Dr. Tim Johnson for many years. He recalled that story in a recent article where he predicts the three problems in healthcare that could “shape the next decade as much as medicine,” which were:

  • Cost
  • Quality
  • Access

Healthcare Lessons States can Learn from Each Other

When it comes to healthcare reform and providing a more value-based system – the New York Times reports that some states have made drastic improvements in certain areas. So what are they doing differently from the rest?

In the United States, where you live plays a huge factor in the type of healthcare services available. As pointed out in the article as examples:

  • Texas uninsured rate is six times higher than the rate in Massachusetts
  • In Maryland or New Jersey – you are four times more likely to be readmitted to the hospital than you would be in Hawaii
  • Nearly one-third of all Texas adults that are of low-income forego care due to cost, in contrast to a mere nine percent in Vermont
  • Healthcare expenditure in Alaska is twice as much per person as the expenditure in Utah

Clearly, when it comes to healthcare cost – location does matter. As stated in the NY Times article, “if all states were to improve to the level of top performers, we’d see gains across the country: 20 million more people insured and 14 million fewer skipping care because of cost; 12 million more adults screened for cancer and 500,000 more children vaccinated; 124,000 fewer hospital readmissions and 90,000 fewer premature deaths.”

Which states are excelling and in which areas? According to the piece:

Stabilizing Marketplaces and Lowering Premiums

Because of the way Obamacare is set up, a major challenge is that a few sick patients increase the premiums for everyone. This challenge impacts the states with small individual markets the hardest. Being one of those states significantly affected, Alaska applied for a Section 1332 waiver, which expands reinsurance options which deliver federal funds to help cover those with unusually expensive conditions. Basically the state of Alaska “reinsures” the insurance companies for high-cost patients, so that this cost does not pass on to healthier people, which also results in fewer premium subsidies paid out. Other states are considering following this example, such as Minnesota.

Tackling Healthcare Prices

Back in 2011, the California Public Employees’ Retirement System (Calpers) revamped how it paid for the most frequent services. The NY Times article explains that analysis of the performance revealed that “California saved $5.5 million on knee and hip operations in the first two years. It also saved $7 million on colonoscopies, $1.3 million on cataract operations, and $2.3 million on arthroscopies. Prices fell by about 20 percent for each procedure.”

Reducing Infant Mortality

Infant mortality in the U.S. is one of the highest among wealthy nations, and the state of Georgia had one of the highest infant mortality rates nationwide. With the introduction of a three-step approach, it has shown the largest improvement in infant mortality rates in the last decade.

The Future of Healthcare Needs Cooperation

U.S. News published an article that discussed the many levels of cooperation that are needed in the future of healthcare. Content within the article covers discussions of problems and the future of healthcare from the recent U.S. News Healthcare of Tomorrow conference.

One aspect talked about at the conference is how private interests can help address the rising costs of healthcare. James Capretta, resident fellow and Milton Friedman chair of the American Enterprise Institute, pointed out how healthcare administrators, physicians, and hospitals have developed innovative systems from the ground up that did not involve direct government involvement. According to Capretta:

“My admonition would just be, do more of that. We need the best minds figuring out how to drive out cost, how to make the patient experience go smoothly, how to drive premiums down by making the cost structure come down.”

The session’s final speaker, Blair Childs, senior vice president of public affairs at Premier Inc., second the points made by Capretta and added that:

“If anybody thinks that health care is going to be fixed by the government or insurers, they’re crazy, because it’s only the providers that are going to innovate.”