In 2010, shortly after the Affordable Care Act (ACA) passed, then-Governor Chris Gregoire said, “We’ve got four years to build a runway so the health care reform plane can land.”
The plane did land, albeit with some turbulence. But with time, the bumpy ride smoothed out, and by 2016, our state’s uninsured rate dropped to below 6 percent, with more than 204,000 people participating in qualified health plans via our state’s insurance exchange and close to 600,000 individuals newly covered through Medicaid expansion. Unfortunately, the Trump administration remains intent on dismantling the ACA, which could create a lot of turbulence here in Washington, where we made greater gains in health care coverage under the ACA than the nation as a whole. Knowing this, Washington state health care leaders must come together to create a system that’s best for all Washingtonians. That system will need to be built on a three-pronged framework of affordability, quality medical care and overall good health.
Control all cost contributors. We cannot drive down the cost curve in health care if the full range of contributors isn’t considered. That means controlling drug prices in addition to everything else. Consider that out-of-pocket health spending on prescription drugs in 2016 increased at the fastest rate in a decade. And in 2017, the Commonwealth Fund reported that Americans spent more per capita on pharmaceuticals than other high-income countries.
Transparency and accountability would make a big difference in controlling costs. Washington should follow California’s and Connecticut’s lead in requiring drug manufacturers to disclose information about drug pricing and cost increases. When physicians and consumers have an accurate expectation of a patient’s out-of-pocket costs, they can make better decisions for the patient.
Let doctors focus on patients. A study by Weill Cornell Medical College reported that medical groups spent 15.1 hours per physician per week dealing with external quality measuring. The cost of those hours? Overall, the study estimated an average cost of $40,069 per physician per year, or a combined total of $15.4 billion annually for general internists, family physicians, cardiologists and orthopedists in the United States. Some 81 percent of practices reported that they spent either more, or significantly more, time dealing with external quality measures than they did three years ago.
Measuring quality is necessary — assuming it is focused on metrics that have a true impact on improving the health of the patient or community. But these activities have a tangible effect, and health care has changed as a result. If a physician’s time is burdened by administrative requirements, it reduces clinical time with patients. As policymakers, insurers and others consider how to measure quality, it’s critical that they consider how implementation translates into application in a busy clinical practice. Standardization of quality measures across the industry would help accomplish the desired goal.
Understand that social determinants affect health. We can’t hope to improve health outcomes, reduce cost, or empower physicians and patients without addressing the impact that poverty has on health care. When patients’ realities of homelessness and poverty aren’t considered, these factors can undermine their health and increase costs.
Now, with a national debate focused on health care, we can implement best practices and innovations to address social determinants that demonstrate a real commitment to a patient- and community-focused health system. Physicians can be a gateway to basic resources their patients need to be healthy, yet this role generally goes uncompensated and adds to the administrative burden because the system isn’t designed to support these activities. Care delivery and payment models need to incentivize screening and navigating patients to community resources.
The physicians of Washington state will continue to lend their voices to shaping the health care delivery system so we can achieve better outcomes, lower costs, improved patient experience and improved clinician experience. Ideally, by standing together, we’ll glide in for a smooth landing.
Jennifer Lawrence Hanscom is executive director/CEO of the Washington State Medical Association. Reach her at firstname.lastname@example.org.