ACA

One can debate many aspects of the U.S. Affordable Care Act (ACA), but there are two benefits to come out of the ACA that I’m particularly excited about. 

ACAThe first is that it promises to expand access to healthcare insurance for a huge population of people that, up until now, never had it. That’s an amazing benefit to those uninsured individuals, and it will be a boon to the healthcare industry’s ability to gather more robust data about these populations. 

As these people come into the system, we will be able to capture their healthcare information. That’s information we never had access to before they were paying customers. Over time, that will be a good thing for the industry as a whole. 

The ACA will also support the trend of moving away from a pay-for-service model to a pay-for-quality approach. We are already seeing this with Medicare and many private payers. 

As more of these pay-for-performance initiatives are implemented, we will begin to see a stronger cross-industry alignment around outcomes. Under a pay-for-performance paradigm, physicians and hospital systems will be more highly compensated for higher-quality outcomes. This will incent them to not only do the right thing, but to focus on the end game – the true outcome measures rather than on the upfront application of treatment. 

All of these changes should lead to better outcomes for all patients, however getting to this state will require a change in the way industry stakeholders work together. To achieve the repeatable quality outcomes necessary to win the financial benefits that come with them, stakeholders need to participate in a more systems-oriented environment that focuses on collaboration with industry stakeholders toward common goals. 

Our recent research suggests that industry leaders see the benefit of such a systems-oriented approach. In our recent Quintiles survey, payers, providers and biopharmaceutical executives all said that the greatest benefit of cross-industry initiatives are improved health outcomes. Payers were also interested in the reduced cost of care, providers believe they will drive improved care experiences, and biopharma executives feel that these collaborations will allow them to get more drugs to market faster. 

The ACA is one more way to incent this move towards a pay-for-performance and system-thinking approach to medicine. Hopefully it will have positive outcomes for us all.