Health reform uncertainty is no reason to stop innovating

By Dodge Communications (not verified) on April 11th, 2012

The healthcare industry is bracing for a potential bombshell in late June. The individual mandate, a key portion of the 2009 Patient Protection and Affordable Care Act (PPACA), may be overturned by the Supreme Court. While the mandate is just one provision in the extremely expansive healthcare law, a lot hinges on its constitutionality.

There are several ways the decision could affect PPACA—and subsequently, the healthcare industry. One possibility is that the current law would be amended—if the individual mandate is declared unconstitutional, it could be written out along with several very closely related items, including a requirement that insurers provide coverage regardless of a patient’s pre-existing conditions. Then again, the entire act could be dissolved with an unfavorable decision. And of course, there’s the strong possibility that the individual mandate will be upheld by the Supreme Court justices, and the various provisions of the law will move forward as planned.

The high degree of uncertainty has put the brakes on many healthcare industry efforts. In regard to the buzz-worthy Health Insurance Exchange (HIX), the turmoil has left many health insurers—and state governments, for that matter—sitting tight, taking the wait-and-see approach. And providers are unsure of how to prepare for the influx of an estimated 16 million newly Medicaid eligible patients under Medicaid’s expansion in 2014.

There has been a lot of criticism placed on organizations—and states—for not moving forward despite the uncertainty. But their caution is understandable, at least in terms of specific provisions.

But it’s unwise to ignore the issues that PPACA has brought to light. Greater care-team coordination and the very noble goals of lowering costs while increasing quality of care, for example. Advancing technologies that can help clinicians, health plans, pharmacies and patients collaborate on care are bound to decrease duplicate tests, reduce medication errors and increase coordination for chronically ill patients. While certain portions of healthcare reform do stand on shaky ground pending the June decision, many of the bill’s core concepts are soundly built.

Luckily, we can see that organizations are committing to these ideas—and in very innovative ways. Many groups, unhappy with the way the Medicare Shared Savings Program’s final rules turned out, took the initiative to develop commercial ACOs that share many key concepts with the CMS agenda. Pharmacies and providers have begun more prudent efforts to share medication data to avoid harmful interactions through partnerships with ePrescribing networks. And payers, with or without established state HIXs, have developed more appropriate individual plans to cater to changes in consumer demographics.

So yes, the healthcare landscape could change drastically in June, but the goals that healthcare reform set out to achieve through its various provisions are still valid and worth pursuing. Fortunately for the industry, there are still providers, payers, pharmacies and vendors that are moving forward on their journeys to developing workable solutions for positive change. Be cautious, but don’t stop innovating.