The Future Success of Healthcare Reform: Thoughts From Alan Sager, PhD
In a session at the Becker's Hospital Review Annual Meeting in Chicago on May 18, Alan Sager, PhD, professor of health and policy management at Boston University School of Public Health, discussed thoughts on the future success of healthcare reform.
Mr. Sager began by discussing the implications of the passage of the Affordable Care Act. "If the Affordable Care Act's Medicaid and individual mandate provisions are implemented, states will continue to cut Medicaid prices for paid caregivers, endangering access and spurring litigation," he said. "Employers, meanwhile, will steadily boost employees' out of pockets and premium shares, and privately financed care volumes will fall." Employers with high volumes of low-income workers will choose to save money by dropping health insurance, paying fines and shifting to exchanges' subsidized insurance, he said.
If the ACA is implemented, hundreds of affordable care organizations will gain strength but will also face high energy-absorbing administrative costs, Mr. Sager said. These include the costs associated with electronic health records and financial systems and demonstrating adherence to 33 quality standards. "It's hard to obtain valid clinical evidence or valid cost data — including average price, average cost and marginal cost — to make careful cost-value trade-offs and spend money more cost effectively," he said.
If the Affordable Care Act is overturned, however, Mr. Sager predicted that hospitals, physicians and insurers will see fewer paying customers. Medicare cuts to hospitals will not be restored, and primary care physician Medicaid fees will drop, he said.
"Either way, employers will keep boosting out of pockets, legitimized by the ACA," Mr. Sager said. "This will deter the use of needed care."
Mr. Sager also discussed the future of accountable care organizations. "ACOs might prove acceptable to patients, doctors, and hospitals — and they might succeed in slowing spending increases while improving outcomes, coordination, continuity and primary care access," he said. An ACO alternative at the state level would be for all payors to negotiate together with state hospital associations over flexible budgets and with physician organizations over fees or incomes, Mr. Sager said. Payors could also provide special enhancements for needed but endangered hospitals and for primary care physicians.
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