Healthcare Reform Opportunities

Now that healthcare reform has been signed into law, its provisions will phase-in over four years. The law creates a number of amazing opportunities. As a healthcare access grantmaker and supporter of high-quality patient care programs in our community, we believe that some of the provisions can help improve access for many previously uninsured people and sustain many struggling programs that provide care for the uninsured. Healthcare reform also treats mental illnesses and substance use disorders the same as other illnesses.

We recently abstracted some key provisions affecting consumers and providers from some Kaiser reports. Our document is on our healthcare reform web site at: http://reform.healthfoundation.org/happening/What%20Changes%20as%20a%20Result%20of%20Healthcare%20Reform.pdf. There is also a 13-page summary with more technical details available at: http://www.kff.org/healthreform/upload/8061.pdf.

One of the things I noticed is how many quality of care and cost containment components are included in the law. There is a partial list on page 5 of the Health Foundation's document. Several things are interesting about this:

• The programs provide for a lot of experimentation that could unfreeze our healthcare system, and which are likely to generate better services and lower costs. Examples include: several programs that help keep people out of institutions and in their own homes; bundled payment demonstrations; and sharing of cost savings with accountable care organizations that maintain quality.

• Quality and cost are linked. A number of efforts are targeted to find the sweet spots between quality and cost. High quality and low cost is the ideal, but in the real world, we are too often closer to low quality and high cost. Examples of what may generate higher quality at lower cost include: establishing a Patient-Centered Outcomes Research Institute; creating a national health quality improvement strategy; establishing an Innovation Center to study payment reforms that maintain or improve quality; and improving patient outcomes reporting.

• There is more funding of and payment for, evidence-based wellness

• Better care coordination is a goal affecting both quality and cost, with provisions to coordinate care between CHIP, Medicare and Medicaid, and to establish a Community–Based Collaborative Care Network.

• States will be given permission in Medicaid to develop medical homes for patients with chronic conditions, certain risks, or serious and persistent mental illness.

My question for you is: How might the Health Foundation best help its grantees and communities to prepare for a lot of change in four years, and to seize some of these interesting opportunities?