2014 is here now

In 2014, approximately 200,000 Sacramento residents will become eligible for health insurance as a result of the Patient Protection and Affordable Care Act. They will be able to see a doctor for check-ups and preventative care. This influx of new patients could potentially overwhelm local health providers. This fact led former California Health and Human Services Agency Director Kim Belshe to declare that, for those running health-care organizations, 2014 is now.

Planning must begin immediately if the health organizations are going to be ready for the changes created by the Affordable Care Act, she said.

On June 7, the Sierra Health Foundation, along with Rep. Doris Matsui, the Public Health Institute and the Teichert Foundation, sponsored a seven-hour symposium on “Mobilizing Care Delivery Improvement in the Sacramento Region in the Era of Health Reform.” Showing up was a who’s who of local and state health leaders, including the former and current California Health and Human Services Agency Directors Kim Belshe and Diana Dooley; the head honchos of UC Davis Health System, Sutter Health, Mercy, Kaiser Permanente, and The Effort; Rep. Doris Matsui, who worked on the legislation; Sierra Health Foundation CEO Chet Hewitt; and Harvard’s John McDonough, who helped write the Massachusetts health bill and worked with the late Sen. Ted Kennedy on health issues.

It was quite a gathering of health wonks. And for seven hours, I was lucky enough to be a fly on the wall while they brainstormed the best ways to prepare Sacramento for the new health-care landscape.

What did I learn? First of all, there is a lot of figuring out still to do.

While there is considerable agreement that President Barack Obama’s Affordable Care Act will go down in history as the most significant advance in health-care policy since the passage of Medicare and Medicaid in 1965, there is much less agreement about how it will be carried out. The health wonks think that the Affordable Care Act provides a great opportunity to improve health care, but they also know it could be a disaster, if health-care organizations do not make smart decisions about how to prepare their groups for the 200,000 people headed their way.

A nationally recognized health expert, McDonough provided an overview of the key elements of the ambitious 800-page health bill. It starts out slow in its first year, with reforms such as banning insurance companies from denying health-care coverage to children with pre-existing conditions; creating a high-risk pool to help people with pre-existing conditions receive health-care coverage; and a favorite at my house, allowing children up to the age of 26 to stay on their parent’s plan. But these provisions are only the warm-up; the act does not really start overhauling the health-care system until 2014.

In 2014, health care becomes almost universal. You are required to get health care from your employer, a private carrier or the government. About 32 million more Americans may have health insurance, another 200,000 in our region. But there’s more. In 2014, the very framework of American health care will be changing.

The foundation of our current health-care system is built on individual practitioners being paid to do individual procedures. This system creates a lot of problems. First, it is very expensive and extremely cumbersome for both the insurance companies and the doctors. Many of our health-care dollars are spent on paperwork and administration. Secondly, the current system has too much emphasis on specialists and not enough emphasis on primary care. Often, the patient is being treated by many different specialists, each working on one isolated condition, while no one treats the whole person. And finally, while there is universal agreement that dollars spent on prevention and education are the most effective expenditures, our current system discourages these.

We’ve basically created a monster. Even though an increasingly large part of our population has no health insurance, and the United States is falling behind on comparative health indicators, we spend twice as much per person as other industrial countries. In 2006, we spent 15.3 percent of our gross domestic product on health care, compared to Canada’s 10 percent, France’s 11 percent, Germany’s 10.6 percent and Britain’s 8.4 percent.

As bad as the current situation is, it also points to a great opportunity. If we can reform the ridiculous aspects of our current health-care system, then perhaps we could actually save money while creating a better one. That is the simple goal of the Patient Protection and Affordable Care Act.

Of course, the bill is clearly a compromise, or it would never have passed Congress. But now it is the law. In general, by expanding health-care coverage, the act provides new revenue streams for hospitals, doctors, insurance companies and drug companies. It cuts back some reimbursements to help pay for the increased coverage. It does this by moving away from paying for procedures and moving towards paying for health outcomes. Instead of being paid for a procedure such as a heart surgery, payment would be geared towards a good health outcome for the patient.

And finally, the act puts a greater emphasis on prevention and education. This is expected to make a major difference in improving health outcomes and reducing costs.

According to Belshe, one of the fundamental changes in health care will be a much greater emphasis on community health clinics composed of a group of doctors, nurses and health educators. Belshe says community clinics have effectively demonstrated how to practice medicine in ways that improve health outcomes by focusing on prevention and education, at a lower cost.

How health-care reform will roll out in Sacramento, in particular, was the major focus of the day. Unlike other regions that have a dominant health-care provider, Sacramento has four large competing health-care systems: Kaiser Permanente, UC Davis Health System, Sutter Health and Mercy.

While there are pluses and minuses of having competing health-care systems, it is definitely more difficult to coordinate health initiatives through four systems instead of one. And the various systems spend considerable effort and money fighting for market share. The millions spent do little to improve health. Imagine, if you will, what that same money would do, if it were spent on health-care education.

At the symposium, each of the speakers supported increased cooperation with each other and community organizations. All of them of work with the Center for AIDS Research, Education and Services. Sutter Medical Center CEO Tom Gagen described how Sutter works with The Salvation Army to provide housing for homeless people after they are released from the hospital. These health-care organizations want to partner with community groups to provide better and more economical health care.

Over the next few years, we can expect a significant increase in the number of Sacramento community clinics. There will be different kinds of clinics with different specialties. CARES, which primarily treats patients with AIDS, will continue expanding their services to handle primary-care functions for AIDS patients, including physical and dental checkups. Individuals whose primarily health problem is drug or alcohol addiction will receive both primary care and addiction treatment at The Effort. For younger women, whose primary health concern is birth control and prenatal care, primary care will be provided by clinics such as Planned Parenthood. There will be clinics with a senior focus, a neighborhood focus and a language or cultural focus.

I left the meeting much more excited than I had been before about the Affordable Care Act. Like many other liberals, I’ve wondered if health reform is really possible without a single-payer system that cuts out the insurance companies. I’ve had worries about the political power of the insurance and pharmaceutical interests fighting health-care reform to protect their profits. And, of course, I’ve been concerned with the Republican effort to sabotage health reform altogether, even though much of the act is based upon Massachusetts’ successful program, as signed by a Republican governor.

Yet aside from the politics, I now believe this law will provide better health care for Americans at a reasonable price. Even though the health-care leaders have never met me and probably will never meet me, I have to say I felt genuinely cared for—as an individual health-care user—after hearing what they had to say.

The honchos were clearly happy that Sacramentans who now lack health insurance will finally have it. They’ll be able to see a doctor when something is bothering them, instead of waiting to get really sick and going to the damn emergency room. When an ailing homeless person is released from the hospital, thanks to a new arrangement with The Salvation Army, they’ll have a place to go instead of sleeping on the street. And soon there will be a system in place to provide help when a struggling mom’s baby gets sick and needs to be made well.

Sitting there in that room with these health-care heavies, I was struck with the difficult task that lay ahead. It will not be easy for Sacramento to be ready in 2014. Nevertheless, I grew more confident seeing who was in the room in 2011.