In early 2017, the heated congressional fight over the future of the Affordable Care Act defined the conversation around health care. More recently, the Trump administration and Republican lawmakers managed to remove the individual mandate — one of the Obama-era law’s central accomplishments — as part of the sweeping tax reform bill passed in late December. The uncertainty has kept local care providers on edge.
“Uncertainty in Washington regarding the future of the Affordable Care Act had a tremendous impact in 2017 and this will most likely continue in 2018,” said Tim Constantine, president of Highmark Delaware. “Our Delaware delegation has been responsive as we look to the federal government to provide clarity on these issues.”
But even as federal shifts in policy have captured the headlines, the sector continues to evolve on its own. New drugs, services and technologies are reshaping everything from access to care to payment systems. Delaware Business Times talked with local players in the sector to learn about what trends are shaping its future.
Underlying health care is the vast and complicated insurance market, which is driven by its own set of incentives and laws. This year, as federal lawmakers seesawed on the ACA, the industry continued to move toward more value and outcome-based payment systems.
“The way we pay for health care is changing,” Constantine said. “Highmark is aggressively migrating away from the traditional fee-for-service provider reimbursement model to a value-based model that is focused on incenting high-quality, cost-effective care.”
Value-based payment systems shift the focus of health care from volume to quality of care, according to its promoters. These types of arrangements between insurance providers and doctors tether payments to specifically defined health goals, such as reducing hospital readmissions and increasing access to preventative care.
Highmark’s True Performance program, for instance, offers additional compensation to doctors for meeting or exceeding defined quality and cost measures. More than 300 Delaware primary care doctors participate. “In 2018 we will see a continued focus on payment transformation, prevention of chronic diseases and increased member engagement,” Constantine said.
For hospitals, specialists and doctors, information is key to providing adequate care. But communication between providers and patients can be difficult, especially when stretched over a region-wide network. This is where programs such as Christiana Care Health System’s Carelink CareNow have stepped up to close the divide.
The program, which launched in 2012 and won multiple awards this past year, uses real-time data technology to capture medical information across the spectrum of care. An interdisciplinary team, which includes doctors, pharmacists and social workers, then uses the data to coordinate services between different providers and their patients.
“Unlike traditional care coordination programs, Carelink CareNow harnesses a real-time information technology platform that integrates information from regional health information exchanges along with other health information — including admission and emergency department visit information, physician visits, lab results, radiologic reports, pharmaceutical use and claims data,” said a Christiana Care spokesperson.
Coordination of care has been a health-care goal for years, but data technology has become more essential to the process. Christiana Care’s system draws from the Delaware Health Information Network and Chesapeake Regional Information Program.
“Siloed models of care are being replaced by more fully integrated models of care,” according to Christiana Care.
Holding onto doctors
Despite technological advances, Delaware still struggles to retain doctors. The lack of a medical school within the state is partly to blame, but it also reflects what some providers see as a lack of incentive to provide primary care.
“Operating your own practice has become something that a lot of physicians are not able to pursue at this point,” Dr. Prayus Tailor, president of the Medical Society of Delaware, told Delaware Business Times. He said added paperwork, payment structures and technological needs have made the job increasingly difficult.
As a result, some doctors have left primary care behind to get into the specialized world of concierge medicine. This emerging field has patients pay doctors directly through a membership model. Though it comes with a high price tag, a number of local doctors are giving it a try.