You may think you've got Obamacare down pat, knowing most of the vital things about it. You probably know, for example, that it calls for people to no longer be denied health insurance due to pre-existing conditions. It also requires people to have health insurance, which is available now in every state via "exchanges," or pay a penalty. There's a lot more you might know or can learn about it, but one part of the massive health-care reform is going largely unnoticed and it's rather revolutionary.
The Patient Protection and Affordable Care Act (referred to sometimes as PPACA or just Obamacare) is looking to turn the American health-care system on its head by providing incentives to get people healthier. This is a win-win proposition, as improved health can prevent many billions in health-care spending, while also extending lives. Until Obamacare, doctors and the greater health-care system generally operated under a fee-for-service system, which can seem reasonable, but doesn't always serve everyone well. In some cases, for example, patients are given more tests than they really need.
Obamacare dares to suggest that health-care providers be rewarded according to how effective they are and how healthy they keep their patients. The old system has been more reactive, with care providers treating people according to the conditions they present when examined. The new vision is more proactive, with care providers doing what they can to keep their entire populations as healthy as possible. Initiatives supported include making care more accessible via extended hours (which has been shown to reduce overall health-care costs by 10.4% ) and promoting a "medical home" model, where teams of health-care providers including doctors, nurses, case managers, and hospitals work together to coordinate the care of their populations.
Home, sweet medical home
Obamacare has some pilot programs in place, promoting Accountable Care Organizations (ACOs) and patient-centered medical homes (PCMHs). Accountable Care Organizations are created when health-care providers, hospitals, and related organizations come together and share responsibility for the health of a particular population. Their compensation will be based on their keeping costs down while also keeping their populations healthy.
Patient-centered medical homes are the "fastest-growing innovation in medical care," according to Consumer Reports, with more than 10% of primary-care physicians, some 27,000 of them, participating. One of the Obamacare-funded pilot programs "is paying 500 practices in eight states to turn themselves into medical homes for more than 300,000 Medicare beneficiaries. If any of those pilots, funded by the new Center for Medicare and Medicaid Innovation, turn out to effectively improve care and lower cost, Medicare and Medicaid can roll them out nationwide without additional congressional approval."
To get a better idea of what this new medical world can look like, imagine these practices as routine: Instead of having to remember what preventive care you need, your health status will be tracked electronically, with you and your health-care providers issued reminders when it's time for, say, a colonoscopy. Instead of having to call your doctor's office for test results, they'll be available online for you. If you're given a prescription or told to get a blood test, your medical home will be making sure that the medication has been picked up and is being taken, and will be following up to make sure the bloodwork is done, too. If you're hospitalized, your doctor's office will be notified automatically. Meanwhile, the hospital won't be reimbursed according to how many services they provide you. Instead, they'll see their rewards docked if patients are readmitted within 30 days or develop infections -- and will earn a bonus if patients report good results and high satisfaction. When a primary doctor sends you to a specialist, the two physicians will be involved in coordinating your care, not just passing you along from one doc to another.
The new medical world will feature teams of care providers, supported by insurers, who are invested in your good and improving health. They'll be aiming to give you effective care and will be rewarded for doing so. While most of us and the media are focused on Obamacare's temporary website glitches, these exciting innovations are not getting the attention they deserve.