Football and the Affordable Care Act

It’s no secret I’m a huge Baylor Bears fan. And Baylor football fans could hardly ask for a better season. Saturday’s game day experience is always one of the highlights of my week. I sit on the edge of my seat watching the plays that work, the plays that didn’t, and thinking about the plays I think could work but just aren’t called. Watching the Affordable Care Act’s implementation is somewhat similar.

Think of the insurance reform components of the bill as the first offensive series that led to a touchdown. There’s no doubt that we need to get more Americans insured, and we are. Now, young adults can stay on their parents’ plans until they’re 26. Starting in 2014, insurers will no longer be able to deny coverage to patients with pre-existing conditions. There’s a new ban on lifetime limits, and beginning in 2014, a ban on annual limits meaning if you get really sick, you won’t end up going into debt. Also, states can now choose to expand their Medicaid programs and in 2014, an additional 17 million Americans could gain coverage as a result. Touchdown.

The second score of the game: the increased transparency and accountability for quality outcomes and patient satisfaction. It’s estimated as many as 76 percent of hospital readmissions are preventable. Now, hospitals are penalized for them, and it’s working. Readmissions across the country are already down two percentage points.

And the third score– the push to get the country’s providers on the electronic health record, which we know will improve patient care, reduce errors, and reduce waste.

As far as the new insurance exchanges, I think it’s third and long. We aren’t sure what the end result will be, but so far it’s clearly been less than successful. Even when consumers can get on the websites, they’re having a tough time determining what they’re buying. It has now been weeks since the exchanges opened, and we still aren’t certain how many plans health systems like ours are considered in-network. It’s changing daily. And just because consumers gain insurance, does not mean they gain access to care. This is a big shortcoming of the Affordable Care Act. There is a serious pending physician shortage. In fact, by 2025, we could be short by as many as 130,000 doctors.

In armchair-quarterback fashion, I think there are a few plays that haven’t been called yet that could be easy scores. Like creating components of the law that would hold more Americans accountable for their health. We could incentivize prevention and wellness. And we also have yet to address the immigration issue which is a significant: one-in-four Texans are uninsured, the highest rate in the country.

So consider that we’re now in the halftime of healthcare reform. What will really determine who wins and loses? Providers like Baylor Scott & White Health need to and will draw up new plays for this rapidly changing environment. We will focus on eliminating unnecessary services; better management of chronic diseases; and improving the coordination of care because the real future is in population health management. And we need to further increase collaboration because bigger teams are stronger teams in this challenging time.

The ACA is not what’s going to really change healthcare in America, it will be the providers taking the field each day that will create the new models of care that improve the quality of care delivered, enhance access to care and do so at an affordable cost. That is the real future. TOUCHDOWN!

Joel Allison is the CEO of Baylor Scott & White Health.

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