Crystal Ball Healthcare Alliance for Health’s Zwarensteyn: The changing landscape of healthcare in 2011
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By Lody Zwarensteyn, President
Alliance for Health
Under the new healthcare law, most U.S. residents will be required to have health insurance by 2014. About 32 million additional people are expected to enroll in some type of health plan. Evidence suggests that insured people consume twice as much medical care as uninsured people, other things being equal. This means that 32 million people will try to double their consumption of medical care.
Who will provide that care? Major changes in 2011 will affect educational institutes, insurer groups, physicians, employers and hospitals (to name a few).
Educational institutions will need to begin looking at the primary care physician shortage and study how this shortage will affect our healthcare system. Even before health reform, the Association of American Medical Colleges estimated that an additional 45,000 primary care physicians would be needed by 2020 to keep up with demand.
In 2011, the health reform law will require insurers to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers if the share of the premium spent on clinical services and quality is less than 85 percent for plans in the large group market and 80 percent for plans in the individual and small group markets.
Physicians and hospitals will continue to experience pressure to implement electronic medical records with the big push coming from Michigan Health Connect and the Michigan Center for Effective IT Adaption.
Employers will begin weighing whether they will provide benefits to their employees. Employer-provided health insurance is the primary source of insurance coverage in the United States, covering almost 160 million people. According to the Henry J. Kaiser Family Foundation, about 90 percent of the non-elderly privately-insured population is covered by employer-sponsored plans, meaning that employer decisions about whether to offer health benefits will influence overall rates of insurance coverage in the United States.
In 2011, hospitals and doctors will be offered incentives, in the form of funding and pilot programs, to change their payment models from the traditional and costly fee-for-service system to one that rewards efficiency and savings. One such model that is receiving a lot of attention is the Accountable Care Organization, or ACO, a touted partnership between specialists, hospitalists and primary care providers where everyone is responsible for the patient's outcome and, presumably, everyone shares in the cost savings.
In summary, change is coming and in 2011, we will note small steps in the implementation of healthcare reform with big changes expected in 2014.