Jim Tallon: Positive Changes Taking Shape in NY Health Care | Archived

An op-ed published in <i><a href="http://www.crainsnewyork.com/">Crain's New York Business</a></i>

Release Date: 04.24.2011

Entire contents ©2011 Crain Communications Inc. Re-posted here with permission.

Health care is at the center of an intense ideological debate about our future. Some doubt whether we as a society can—or should—assure care for all, whether we can better control costs and whether we can agree on an approach.

As is often the case with political debate, negative messages grab the headlines.

But on the ground, big changes are coming to health care. The federal health reform law has paved the way for innovative care models. Albany is tackling some of its biggest challenges with Medicaid. Anticipating more people with insurance coverage, health care providers are changing the way they interact with patients, with each other and with those who pay the bills. This is the most active period I've seen in decades.

Here are some specific advances to improve care that merit special attention:

Primary care. All patients need convenient access to a team of providers who deliver continuous support for the full range of their needs. Health reform efforts pave the way for “medical homes” to move beyond isolated, 15-minute doctor visits and fragmented care. An up-front coordination fee from insurers promises long-term cost reductions through improved follow-up care, monitoring of test results, medication reviews and open lines of doctor-patient communication.

Accountable care. The federal government, through Medicare, and New York state have authorized accountable care organizations to integrate primary care with specialist and hospital services. With this new category of providers, electronic records replace the clipboard, repeat tests and overlapping referrals. Payments based on overall performance rather than on individual visits and procedures incentivize better coordination, which lowers overall costs. We'll be seeing a variety of these organizations take shape in the years ahead.

Medicaid. New York's $50 billion program is embarking on a major expansion of managed care and medical homes for its most complex and costly beneficiaries. It is bridging multiple medical specialties for patients with two or more chronic illnesses, better managing behavioral services for those with mental health conditions, and coordinating acute and long-term care for the elderly and disabled with both Medicare and Medicaid coverage. Because just 20% of Medicaid patients account for 75% of program costs, these efforts are critical.

None of this is simple. These initiatives require a major investment in electronic records, which is under way. Collaboration among Medicare, Medicaid and private insurers is also necessary to ensure strong incentives for improving service delivery and containing costs. We, the patients, need clear explanations of our new responsibilities and expectations. Tough evaluation of whether costs are lowered, quality is improved and participants are satisfied is essential.

Public debate also plays a critical role. But rather than focus on the legacy nonsystem of decades past, that debate should reflect the smarter health care system that is emerging.

Jim Tallon is president of United Hospital Fund.


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