Last Thursday the Supreme Court got us a present for our birthday, the plan we deserve, aka the Affordable Care Act. It was a grand compromise of a bill and a decision that each person in the country can love and hate at the same time. There’s something for everyone, but there’s mostly a lot to love if you’re in patient-centered Health IT. Patient-centered IT will become center stage under ACA and drive Health IT even more, and in a whole new direction than HITECH. Let’s talk a little bit first about why we can all be thankful to be unhappy to get the health care bill we deserve, then what it means for Health IT.
The Bill We Deserve
ACA is a quintessentially American piece of legislation becoming law of the land (again) in a quintessentially American process: narrowly enacted piece of legislation narrowly upheld by the courts, with the left politically championing a right-leaning solution and a Conservative Chief Justice going against the right to defend the soul of Reagan/Bush conservatism and personal responsibility: the individual mandate. A crazy sequence of events leaving us with a solution that nobody likes a lot, but we can all appreciate as being the health care bill we deserve and a pretty good fit for where we are as a country.
The right is already saying “Send it back!”, but, now that the dish is too cold to return the the kitchen, I suspect many on the right to be saying, “OK, maybe it’s not exactly what we thought we ordered, but it tastes pretty good.”
Soon the Left will begin staring at their health care plate, wondering “Is this what we ordered?”
It’s been said many times that the sign of a good compromise is leaving everyone dissatisfied, and that’s certainly true here. We could simultaneously see this as conservative Jiu Jitsu getting Obama to champion conservative legislation and take the blame for it, or Obama Jiu-Jitsu in stealing Romney’s plan and taking the credit for it.
Despite all the political maneuvering from the left and right, the reality is that there’s something for just about everyone to hate and to love in the legislation.
If you believe that the individual mandate impinges on your freedom and that this amounts to a government takeover of health care, remember that the individual mandate grew out of the Heritage Foundation as a way to promote personal responsibility and would amount to a “government takeover” of health care by private insurance companies. As Newt Gingrich said in 2007: “citizens should not be able to cheat their neighbors by not buying insurance, particularly when they can afford it, and expect others to pay for their care when they need it.”
If you wanted a single-payer type system, know that conservatives wouldn’t even vote for their own plan, so a single payer wasn’t ever going to happen any time soon, and this is the best solution to get any time soon and it’s already a bit late. Still, better late than never.
In a country where most folks are not prepared to turn people away at the ER door, we want (or have) to keep private insurance companies, and we can’t politically do single payer, The Accountable Care Act, ObamaRomneyCare, and the the individual mandate really is the only workable compromise. There’s not much left in the middle.
I think on some fundamental level Justice Roberts understood that the law was conservative, hatched in conservative think tanks. That’s why in March I picked Roberts to vote in favor while Kennedy would oppose. For Roberts to overturn the individual mandate would have been for him to overturn a foundation of conservative policy ideas from the past 20 years.
That’s far from being a traitor as much as a champion of conservative ideals. Conservatives have been role-playing the defense of the individual mandate for 20 years assuming they’d be the ones defending it.
This is the best we could do and it’s here to stay. If you’re looking for someone to “repeal” the legislation, it likely won’t be Romney who is one of the fathers of the individual mandate for health care.
Everyone cheer, we’re all unhappy!
What it means for Health IT
This was a big step and a huge change for health care in America and has potentially even bigger implications for health IT and health data, which will become ever more important as the incentives, the constraints, and the entire landscape of health information has now shifted dramatically. If you’re unhappy for this or many other reasons, if you’re in health IT, ACA is still very positive. The door is now open for what I’ve been calling a “health information economy” for the last several years and this could lead to a much broader economic boom for the country. I’ll quickly recap the two main reasons why (and I’ll talk about the implication more in weeks and months to come):
First: No termination of insurance for pre-existing conditions means more health data flow.
I wrote when the final vote was coming for ACA that I hoped it would pass because it would free up health care data. My hypothesis is that people will be far less concerned about sharing their health data when they won’t be at risk for losing their insurance. I suspect this is still the case, but we won’t know fully until 2014 and the law takes effect. If PatientsLikeMe is any indicator, people will gladly exchange personal data in the hope that it will lead to a better outcome.
Second. ACOs and HIEs and insurance exchanges mean that data is money.
Those that drill for it, refine it and exchange it will be like oil companies. It’s a greenfield and a blue ocean. A KLAS report came out on Friday saying that 55% of providers are looking at business intelligence solutions. One CIO in the report is quoted as saying “If hospitals can’t produce data analytics in the next couple of years, they are going to suffer. As far as I am concerned, data is money in the future.”
I agree. The subtext of the report here is that under new ACO or accountable care models, providers are assuming risk. Data is at the core of how they will go about managing risk, but data will only get them so far without the architecture to connect people.
Data, Architecture and Engagement
The key to success in provider risk assuming, patient centered, and quality-focused areas will be a three-pronged approach of Data, Architecture and Engagement.
Data and more, bigger data is just the first step. The more data from the EHR and far beyond the EHR, the more questions you can answer. ACA means big data is big money in health care, but finally, not to cull the at-risk patients.
Many providers are seeing this as a quality-control measure. For instance, to reduce excessive readmissions, they need better data about what happens at the hospital. But that is a small part of the story. Keeping people from getting readmitted has more to do with what happens in the first 30 days at home than it does about what happened to them at the hospital.
For that, we’ll need new patient-centered architectures that not only connect larger data sets, but in their very organization can connect people with new communications workflows, including social media. The basic idea is that by connecting different stakeholders on the same architecture means that they can find ways to solve problems, thereby reducing risk in a free-market kind of approach.
The final piece is engagement, once the architecture is set up (a big opportunity for HIEs or others), providers will need to connect and coordinate with individual patients to drive down costs. Population solutions to population problems won’t get the full benefit of patient experience. With ACA, we are now firmly headed toward consumer-driven medicine, and that means more, better data, more better architecture and more better patient engagement.
Personal Responsibility and Independence Day
Gregg Masters asked me in an interview on ACOWatch on BlogTalk radio what my definition of “engagement” was after my last post on engagement as the triple-aim linchpin. Is this just a new buzzword? I told him that the definition of engagement is that people are actively involved in the decisions that affect their health. That means having a better understanding of the consequences of their health care decisions. In order to be responsible, people will need to engage with the system and become a more integral part of the decision-making process and add in their own goals. It’ll be their money and health on the line. Their own contexts must be added into the decision spaces of health care. Right now, much of health care decisions happen in the population space rather than individual decision space. Eric Topol writes about this in the Creative Destruction of Health Care, and this will be the topic of my next post; moving from populations to individuals is at the very heart of ACA and health reform.
So anyways, have a great Independence Day! If you can, be just a little thankful for our twisted political system, and our strangely effective system of checks and balances for giving us the health care the country deserves. We can now move forward toward the health care that each of us deserve through better data, more freedom to choose your plan and more personal responsibility for your health.