The Year of Uncertainty

The year 2011 could be called the year of uncertainty in health care. With so many of the details on the implementation of the Affordable Care Act yet to be determined the entire health care community spent much of the year engaged in contingency planning. States, Georgia among them, began to move forward on developing implantation plans while awaiting draft regulations that would give them guidance as to how to proceed. The Federal government slowly released regulations and analysis that would help clarify matters, but often passed the responsibility for decision-making back to the states.

A clear illustration of this uncertainty was provided over the last 10 days. The Governor’s Exchange Advisory Committee’s Report released this week outlined broad principles for implementing health insurance exchanges in Georgia contingent on the direction of Federal regulations. A major uncertainty identified by the committee was the determination of the essential health benefits package. This essential health benefits package will affect the private insurance products offered to all Georgian’s whether they get coverage through their workplace, as individuals or within the Insurance Exchanges. The committee offered contingency plans dependent on the Federal determination of the essential health benefits package. Last Friday the Department of Health and Human Services issued a proposed policy of allowing each state to determine its own essential health benefits package. While that policy creates more flexibility for the state, it does nothing to decrease uncertainty around the shape Georgia’s future insurance market. Now state policy makers will need to resolve that issue.

The coming year appears to be one of resolution for at least part of the uncertainty. The Supreme Court will rule on the constitutionality of some parts or all of the law. The election of 2012 will shape the political future of the law. Importantly during this year decisions on the implementation of the major health insurance reforms need to be made by the Federal government and by the states to have any chance at ‘going live’ on January 1, 2014.

Perhaps as important to the future of the country’s health care delivery system are several changes and experiments in the Medicare program that begin in 2012. Among these changes are payments to Accountable Care Organizations (ACOs) under Medicare. While there are a number of structural and legal issues surrounding ACOs the basic idea of an integrated system of care is seen as the framework for controlling health care costs for all patients in the future.

Coupled with changing the structure of health care delivery organizations are changes in reimbursement mechanisms. Beginning in 2012 the ACA begins a program under Medicare to pay hospitals based on performance on quality measures. It also requires the Center for Medicare and Medicaid Services to develop similar payment mechanisms for skilled nursing facilities, home health agencies, and ambulatory surgical centers. Some states will also participate in experiments to begin similar payment mechanisms under Medicaid.

These changes in structure and reimbursement continue trends that have been occurring for at least 20 years, but the Affordable Care Act is intended to accelerate the evolution of the health care delivery system. The New Year will be about making the choices that begin to resolve the uncertainty that characterized 2011. Those choices will shape Georgia’s health care system for the rest of this decade and beyond.

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