The next set of chal­lenges

Now it’s time to move on to is­sues in­volv­ing ef­fi­ciency, sus­tain­abil­ity

Modern Healthcare - - OPINIONS COMMENTARY -

For em­ploy­ers, last week’s U.S. Supreme Court rul­ing clears up the le­gal un­cer­tainty that had sur­rounded the Pa­tient Pro­tec­tion and Af­ford­able Care Act and af­fected ev­ery­one’s abil­ity to move for­ward with cer­tainty. Em­ploy­ers that spon­sor health plans can con­tinue to im­ple­ment the law’s pro­vi­sions re­quired in the next cou­ple years.

Th­ese pro­vi­sions in­clude pro­vid­ing em­ploy­ees a gov­ern­ment-man­dated sum­mary of their ben­e­fits and cov­er­age, re­port­ing the value of health ben­e­fits on em­ploy­ees’ W-2 forms, au­to­mat­i­cally en­rolling em­ploy­ees in a de­fault health plan if they do not choose one, and cov­er­ing all em­ploy­ees who work at least 30 or more hours a week. The rul­ing also means that em­ploy­ers must con­tinue the plan ben­e­fit changes and plan rules that they had al­ready im­ple­mented, in­clud­ing ex­tend­ing cov­er­age to adult chil­dren to age 26 and manda­tory in­de­pen­dent re­view of cov­er­age de­nials.

With pre­dictabil­ity, we can all re­fo­cus on find­ing so­lu­tions to the chal­lenges not re­ally dealt with in the law, in­clud­ing the need to control costs, the need to elim­i­nate waste and overuse, and the need to use sys­tem and busi- ness process re-engi­neer­ing to im­prove pro­duc­tiv­ity in the health sys­tem. We can also work to­gether on pay­ment and de­liv­ery sys­tem re­form.

The Na­tional Busi­ness Group on Health and em­ploy­ers will con­tinue to work with the reg­u­la­tory agen­cies to avoid un­in­tended con­se­quences of the pro­vi­sions of the law and to en­sure the flex­i­bil­ity re­quired to ac­com­mo­date a mul­ti­tude of dif­fer­ences among em­ployer plans. Flex­i­bil­ity will be par­tic­u­larly im­por­tant as em­ploy­ers as­sess and ad­just their ben­e­fit plans to en­sure that they com­ply with the ACA’s re­quire­ments for the em­ployer man­date and the loom­ing ex­cise “Cadil­lac tax.”

To­day’s rul­ing also means that em­ploy­ers, states, the fed­eral gov­ern­ment and in­sur­ers must re­dou­ble ef­forts to work with hos­pi­tals and physi­cians to im­prove health­care de­liv­ery. Though the ACA is ex­pected to ex­pand cov­er­age to 30-plus mil­lion pre­vi­ously unin­sured peo­ple, which is de­sir­able, it would truly be a wasted op­por­tu­nity if we all ended up pay­ing for bil­lions of dol­lars of care that is de­liv­ered in­ef­fi­ciently and in some cases un­nec­es­sar­ily.

We ap­plaud and sup­port the new ini­tia­tive by lead­ing physi­cian spe­cialty as­so­ci­a­tions to iden­tify the most com­mon overused and un­nec­es­sary pro­ce­dures and take steps to re­duce them.

In addition, lead­ing em­ploy­ers have worked with a num­ber of hos­pi­tals and health sys­tems to stream­line their pro­cesses of care de­liv­ery and their man­age­ment of care, shar­ing their meth­ods for con­tin­u­ous qual­ity im­prove­ment, bet­ter sup­ply-chain man­age­ment and more ef­fi­cient op­er­a­tions with great re­sults. With more joint ef­forts like this, the health­care com­mu­nity and em­ploy­ers and other pay­ers of health­care can en­sure the long-term sus­tain­abil­ity of ac­cess to af­ford­able, high-qual­ity, per­son­al­ized health­care de­liv­ered with world-class ef­fi­ciency.

He­len Dar­ling is pres­i­dent and CEO of the Na­tional Busi­ness

Group on Health

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