Taking the Long View
Although Dr. Kazi says he sees the ACA as “one step toward greater equity and transparency and a value-based healthcare system,” he stresses that additional reforms will be needed. To truly meet the law’s aims, he says, the healthcare system likely will need to move toward more uniform prices to eliminate the incentive to see some patients but not others, and to provide more incentives to maintain continuity of care. Third, it may need to group treatments for conditions like rheumatoid arthritis as a single episode of care, in order to align incentives to work together as a coordinated team of providers.
A successful system of exchanges, however, could have several long-term consequences. “If, in fact, the exchanges offer good insurance products that the public begins to accept and find that they have good information to make choices, it could affect the prevalence of employer-based insurance,” says Robert Berenson, MD, an institute fellow at the Washington, D.C.-based Urban Institute, a nonpartisan think tank focused on social and economic policy. Over many years, employers could begin moving their employees into exchanges rather than providing direct healthcare benefits.
“If the exchanges work as advertised and they end up having a very competitive landscape,” Dr. Laing says, “maybe people will be a little more tuned in to what their coverage is because they’ll actually have to shop for it rather than having a limited number of choices.” This comparison shopping, in other words, could increase consumers’ awareness of costs and benefits and aid discussions with rheumatologists.
A viable exchange system also may help accelerate the trend toward more consolidation of physician practices or alignment with larger entities. Despite concerns over skinnier networks, for example, the more tightly controlled access to providers under certain plans dovetails with the ACA’s heightened emphasis on more integrated accountable care organizations (ACOs).
