Posted in Accountable Care, ACO, Affordable Care Act, digital health

ACA, Accountable Care and the @HealthcareGov Fiasco

By Gregg A. Masters, MPH

With the quiet time afforded this ‘Thanks Giving-Kah’, I feel called to express some ‘dis-ease’ with the progress towards our pursuit of the triple aim or sustainable healthcare ecosystem.

healthcareGov cartoon

As if the health reform battle hasn’t been a power partisan exchange from day one. Think again…

If you weren’t paying attention during the run up to the Act’s passage in March of 2010, be reminded that the process was NOT imbued with the goodwill and fair consideration of grounded health policy arguments – both pro and con – to vet what might emerge from our bi-cameral legislative process and stand in the marketplace of ‘workable reform’.

But who among us could have predicted that health information technology performance or more accurately the lack of said ‘e-commerce performance’ might emerge as the likely candidate fulfilling the oppositions’ intent to stand in the way of ‘real’ health insurance for some 75 millions Americans?

Seriously HealthIT as the tipping point in the demise of the Act? Who saw that? As noted by a colleague on twitter:

Margalit Gur-Arie ‏@margalitgurarie 20 Nov
@2healthguru Oh yeah If someone said a year ago that Obamacare will fail on account of technology, I would have laughed them out of the room

In the midst of 46 attempts by the Republican controlled House to defund or repeal the ACA, a tapestry of lawsuits filed by AGs in ‘red states’, an unexpected SCOTUS affirmation of the law coupled with ‘discretionary’ state participation in the Medicaid expansion provision, and relentless Tea Party backed efforts to tag the Act as the end of freedom itself and the institutional permanence of ‘big government’ in the lives of all Americans – what most failed to appreciate is the market based nature of the effort. Health reform and the provisions in the Act express macro trends deeply rooted in the connective tissue of provider/payor/patient/consumer marketplace experience, wholly independent of the exquisitely orchestrated though faux political narrative – the crown jewel in the playbook of ‘weapons of mass deception’.

I have been in the ‘managed competition’ side of this business for 3+ decades and often can’t understand the nature of the beast we’ve created. The ‘healthcare conundrum‘ so aptly coined by Atul Gawande quite some time ago is a complex and unwieldy beast I have affectionately tagged the ‘healthcare borg‘ as a reference to the ‘resistance [as in change] is futile’ reference in Star Trek. Yet, many who lack even an undergraduate grasp on the nature of the American sick-care economy are unreasonably certain in their opinions on the nature of the malady and what might pass as proper remedies. Unfortunately, this certainty seems to be rooted in cheerleaders who might be characterized as ‘frequently wrong, but never confused.’

In this absence of anchorage to facts and contextual truths where is one to start in an ideological fueled echolalia of lies, misrepresentations, partial truths architected by armies of K-street funded special interests and their partner PR machines? Unfortunately for the rest of us K-street and the balance of the often morally bankrupt (chase the buck) beltway bandits find gold in them their hills of fueling ‘conflict’ as a contractual or ‘annuity solution’ to their recurrent ‘bill-ability’ concerns.

Let’s be clear. If the ACA were repealed do you think any of the macro trends would slow or reverse? Would Accountable Care be set aside for an ‘unaccountable care’ status quo? How about the movement into value based or performance based payment? Might this be moved to the quicksand of failed ideas while the return to fee for services ‘happy days’ plays on and on? Will selective movement into direct or retainer based medicine somehow disappear as well (note the return to direct practice is merely the reinvention of the HMO only in more micro practice terms)? Or will care management and coordinated care be seen as merely a passing fad with an immediate return to silo based episodic care and unit revenue or pricing maximization? I don’t think so…

None of these granular market tectonics would reverse if the Act were to be defunded, repealed or somehow re-litigated in the court of public opinion or elsewhere.

So let’s place the change or transformational energy impulse where it can best serve us. Since we’ve just recognized the 50th anniversary of the tragic JFK assassination I’m reminded of this bit of timeless wisdom:

‘if you’re NOT part of the solution, you are [part  of] the problem.’

Have you looked in the mirror lately?

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