None of the Ransomed Ever Knew How Deep Were the Waters Crossed

By Gregg A. Masters, MPH

Ah yes, those ‘white waters’ of health reform or more aptly put ‘transformation’ (you know, the triple aim thingy). As more has been revealed, I offer a quasi ‘mea culpa’ of sorts…

Light years ago, or so it seems, as I began at least the blogging portion of my social media participation I penned this post, headline below dateline: August 18th, 2009 – pre-passage of the Affordable Care Act.

Health Reform 101 – ‘None of the Ransomed Knew How Deep Were the Waters Crossed!

The intention was to frame the ‘grand canyon’ nature of the challenge (many were called, but all failed), and contextualize the likely ‘win’ from the eventual ‘against all odds’ success of national health reform.

It further signaled an impending hollow if not ‘pyrrhic victory’ followed by the recognition of certain legacy health insurers of the ‘burning platform’ nature of their business models. Bottom-line, the industry needed to reinvent itself as ‘value added’ players if not architects of a sustainable ecosystem less they find themselves at risk of extinction. A ‘racket’ of collecting large group ASO fees, while reducing covered benefits, and floating ever increasing premium to their clients (lets leave the small group and individual market disasters out at this point), just doesn’t cut it anymore.

I opined at the time, that the net effect of the ambitious health reform effort would be a sellout on top of a sellout, i.e., the abandonment of the public option, Medicare ‘E’ (everyone), and the categorical rejection (no consideration) of single payer as a potential solution. And worse yet, albeit via subtext, was to anticipate the storm of premature ‘strategic solutions’ typically proffered by ‘name plate’ consulting firms supported by armies of junior MBAs (on site associate project managers) with clipboards, ties and not ready for prime time answers.

While legitimate concerns at the time, the broad tapestry of the Affordable Care Act (the reconciled compromise), and the range of creativity its fostering in the accountable care space, including patient centered medical homes, and derivative accountable care collaborations both payor and provider led, have caused me to pause and be more hopeful that in the aggregate, there may be more magic in those 906 pages than may be apparent at first blush.

I keep coming back to @Aetna as one legacy health insurer’s ‘re-positioning’ (from @iTrage as a payor agnostic platform to ‘accountable care collaborations’ engineered via their Accountable Care Solutions Group) as indicia of a genuine commitment to build a sustainable, transparent, affordable, accessible and value driven healthcare ecosystem that actually works. Time will tell…


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