With the re-election of President Barack Obama to a second term, Mitt Romney’s promise to repeal health care reform on his first day in office has faded from political reality. Instead, health care reform will continue to move forward apace. Chas Roades, the chief research officer at The Advisory Board Co. and a health policy expert, recently spoke at Brown University, detailing his view of future health trends.
After his presentation, Providence Business News asked Roades to share his insights about the future delivery of health care in the nation – and Rhode Island.
PBN: How will patients be able to change the conversation in taking more control over their own health care?
ROADES: We’re seeing a proliferation of new approaches to help empower individuals to make smarter decisions about where and when they seek care, and from whom. The push toward greater transparency of cost and quality data, along with the rising prevalence of health benefits designs that shift greater cost to individuals in the form of higher co-pays and deductibles, have created a market in which we’re already being much more judicious in our use of health care resources. The challenge will be to make sure that we encourage the right health behaviors, and avoid discouraging appropriate use of health care services.
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PBN: What are the strategies that states can pursue to control medical costs, improve quality outcomes, and increase affordability?
ROADES: One of the biggest levers states will have across the next several years is in the design of the new health care exchanges. Depending on how the rules of the road are set for those exchanges, states can encourage insurers and providers to shift to much more value-driven approaches to care. At the same time, states can design benefits for public sector workers that harmonize with those exchange rules, and also have the ability to shift Medicaid benefit designs in a similar direction. Between those three populations, states can have a huge impact on the overall direction of the health care market.
PBN: What role do you see community health centers playing in the future health care delivery system?
ROADES: Community health centers are an increasingly critical part of the safety net for lower-income individuals. One of the most exciting developments in this part of the market is the adoption of better approaches for care management – new care strategies that assist chronic disease patients with managing their health, and reducing the need for hospitalization and emergency room visits. We’re seeing increasing interest among larger health systems in finding ways to integrate community health centers into the broader continuum of care.
PBN: Are shared savings contracts, global payments, and the movement away from fee for service business models effective in putting health care on a budget?
ROADES: There’s no question that the shift toward risk-based models of reimbursement will be the dominant payment approach moving forward. Payers and providers alike recognize that simply paying hospitals and doctors more and more for higher levels of activity creates perverse incentives and results in a high-cost, inefficient system. Ultimately, we’re headed toward something that looks like capitation – paying providers a fixed fee each year to take care of a population of patients. The hope is that this approach will finally get everyone’s incentives aligned around providing the right care, at the right time, in the right place – and paying much more attention to quality of care.
PBN: How can businesses leverage workplace wellness campaigns to lower health care premiums – for those who are not self-insured? Are there new metrics needed?
ROADES: We’re seeing a resurgence of interest in a wide range of workplace approaches among employers – putting real dollars on the table to incent employees to engage in wellness activities, providing heavily discounted access to preventative visits, partnering with local providers to provide disease management services to high-cost employees, and even a return to onsite workplace clinics. In general, employers realize that they just can’t afford to swallow double-digit premium increases every year—they’ve got to get more aggressive about working with local providers and their own employees to bend the cost curve.
