Understanding the Affordable Care Act
What shouldn’t get lost in the conversation about coverage is how reforms will impact the health care experience. With the probable expansion of Medicaid and hundreds of thousands of residents insured for the first time through exchanges, some predict that a shortage of primary care providers could derail some of the hoped-for results. The Washington State Office of Financial Management forecasts that most urban areas will be able to accept the increase in new Medicaid patients with the current primary care physicians, but that rural counties will face challenges.
Providers around the region are already shifting the way care is delivered in ways that anticipate the new order. “We need new models for primary care,” says Group Health Cooperative’s Armstrong, whose organization redefined its primary care with the introduction of the medical home model, a patient-centered approach using teams (doctors, nurses, physician assistants, pharmacists, etc.) to care for patients, the addition of electronic medical records for efficient access to patient information, the introduction of doctor-patient e-mail communication and the redesign of some of its facilities to provide all the services a patient needs in one location. These changes have resulted in happier and healthier patients—and lower overall health system costs for Group Health.
One way of addressing the potential physician shortage is through the use of advanced nurse practitioners, according to Barbara Trehearne, Ph.D., R.N., vice president of Clinical Excellence Quality and Nursing Practice for Group Health. “Here in Washington, laws allow licensed nurse practitioners to diagnose and treat patients in the same way an M.D. would,” Trehearne says. As physician groups and clinics move to a team approach, patients should expect to see more physician assistants and licensed nurse practitioners playing key roles in health care.
For Virginia Mason’s Kaplan, health care reform isn’t just about reducing cost. In 2011, for example, Virginia Mason opened the Floyd and Delores Jones Pavilion, the first-ever facility built using lean principles. Surgical teams operating in the pavilion were able to reduce patient wait times from check-in to surgery by 36 percent. By redesigning workflows in the orthopedic therapy room, walking distance was reduced by 81 percent, resulting in more time for nurses and staff to devote to patient care. These innovations have contributed to Virginia Mason ranking in the top 15 percent nationally for patient satisfaction.
For their part, new patients need to be proactive, especially in selecting a primary care physician, who takes the lead in planning and managing a patient’s care with specialists, hospitals, pharmacists and even nursing facilities. “This type of care management will be especially important as patients come into the market for the first time or after a long absence,” says The Everett Clinic’s Cooper. “Many will have chronic conditions, such as diabetes, asthma, heart disease and hypertension.” Comprehensive and coordinated care will ensure better health at lower costs.
For readers researching Top Doctors, it’s important to see the pediatrician, internist, surgeon as a member of a team—and to recognize that other well-qualified members of that team, including other physicians, may often be more readily available to provide care and have access to the patient information needed to treat basic illness, refill a prescription or handle a referral quickly and efficiently.
Amid all these changes, it’s still too early to tell what will actually be accomplished with health care reform. “In an ideal world, this legislation would increase access to care, improve quality and make health care more affordable,” Cooper says. “Much will depend on how the law is implemented in 2014. Then we will know if the national effort to improve health care qualifies as true reform.”