6 health IT leaders: Key thoughts on AHCA

The House of Representatives passed the American Health Care Act earlier this year; the Senate is currently working on its version.

The AHCA would repeal the Affordable Care Act and replace it with new framework for the healthcare system.

Six executives from health IT companies discuss how the American Health Care Act could affect healthcare in America if passed into law.

Jon Elwell, CEO for Kno2 (Boise, Idaho): "Regardless of whether the AHCA is passed into law, it's critical to maintain focus on the fundamental issues: healthcare delivery costs must be controlled, inefficiencies eliminated and quality improved. To do so, healthcare stakeholders will need to embrace interoperability, which will directly lead to lowered healthcare costs, improved care coordination and enhanced patient outcomes. Make no mistake; connecting all of the stakeholders to attain this shared vision is no longer a nice-to-have — it's a must-do."

Tom Borzilleri. CEO of InteliScript (San Diego): "If the current bill becomes law, millions of patients could lose their prescription drug benefits, even if they keep their health insurance. That's because the bill would allow states to opt out of prescription coverage — an essential health benefit mandated by the ACA. If the states decide to waive coverage, then market and retail prices will be effectively set by pharmacies, which can have a very significant financial impact on the consumer. This policy will not save money in the end because patients who can't afford their medications won't take them, and many will end up back in their doctor's office, or worse, in an emergency room or hospital. Instead of restricting access to prescription drugs, we need a comprehensive plan to increase drug price transparency and drive down prices. If drugs cost less, covering them will be less onerous for private and public payers. Also, affordability drives adherence and patients will take their drugs properly, reducing costly avoidable hospital readmissions."

Dr. Tom Sullivan, chief strategic officer with DrFirst (Rockville, Md.): "It's a bit early to predict the full impact of the final healthcare reform bill since the Senate takes a longer view, which may well inform their thinking. However, I am very concerned that the loss of prescription drug coverage for indigent and disadvantaged patients will result in higher drug prices for many important drugs. This will likely have an impact on patient medication adherence for these potentially vulnerable populations. I'm also concerned about the impact on the price of Naloxone, which is an important tool as we continue to struggle with the opioid addiction crisis in the U.S."

Rebecca Cofinas, Founder/CEO for AristaMD (La Jolla, Calif.): "The underdogs of healthcare — the underserved, the sick and the elderly — will be further burdened by changes introduced by the AHCA, should it become law. Loss of healthcare coverage does not make healthcare needs disappear; it only makes those without insurance suffer. Patients may choose to avoid much-needed care, resulting in ever-increasing emergency room visits, hospital admissions and readmissions. The end result: poor patient outcomes at an even higher cost, with hospitals and physicians caught in the middle. This proposed change isn't good for anyone. Not the payer, not the provider and definitely not the patient. It will be up to the states and committed healthcare providers across the country to seek innovative, cost-sensitive solutions to try to meet the healthcare needs of the most vulnerable among us."

Heather Kawamoto. VP of Revenue Cycle Management, Recondo Technology (Greenwood Village, Colo.): "Any way you slice it, there's going be a reduction in coverage. With declining consumer coverage, providers will have fewer dollars to reinvest in technology and to cover patient care. As a result, providers will seek to shift costs to make up what they're losing by increasing what they charge payers. Payers may budge a little on price but not much, which will leave patients to pick up a bigger share of the cost. Caught in the middle will be everyone who has health insurance as a workplace benefit — their premiums and out-of-pocket, especially, will go up. And everyone will go looking for low-cost options, so we may even see price shopping by consumers. We will also see hospitals taking on more bad debt as more patients are unable to meet their financial obligations. Hospitals can help by making those obligations more transparent up front. They have an opportunity to work with patients on how best to cover the cost of their care, and the options are much better when you have the conversation sooner rather than later."

Rose Higgins, President, North America, SCIO Health Analytics. "The AHCA as currently proposed by the House will raise the stakes much higher around risk for payers, providers and patients. The industry will need to get better quickly at predicting risk accurately to guide plan design for payers, help payers and providers manage changes around what constitutes a pre-existing condition (and whether it's covered in that state), and support consumers in making choices that balance significantly higher premium costs against the possibility of very high out-of-pocket costs. Providers will also have to account for the potential reduction in eligibility for Medicaid, and a significant reduction in federal funding of Medicaid programs which will increase their financial exposure. If healthcare becomes unaffordable for lower-income citizens their utilization of the emergency department as their primary care is likely to increase. The resulting need to control costs will likely accelerate the transition to value-based care."

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