What the Affordable Care Act means to you

By Dr. David Lopalosky

Although not perfect or free of controversy, many changes resulting from the Affordable Care Act (ACA), also known as Obamacare, are good news for health care consumers. The ACA includes comprehensive health insurance reforms that expand coverage, hold insurance companies and health care providers accountable, lower health care costs and guarantee more choice while enhancing the quality of care.

In response to ACA provisions, health care insurers, health systems, physicians and others are directing their efforts to coordinate care, improve health care outcomes and hold the line on costs while improving the patient experience.

Here are some ways ACA is changing the face of health care.

Patients will be able to make informed choices about where they receive their care by having access to important quality measures and outcomes as well as patient experience results for specific providers. When planning to have an elective procedure, such as knee replacement surgery, a patient could compare outcomes and costs for that procedure at several competing facilities. Armed with that data, the patient could make an informed choice about where to receive care.

Quality and patient experience data for individual physicians will become available, too. Data will come from patient experience surveys, administered by third parties to remove bias, randomly sent to patients after a health care encounter. By using this data patients can choose physicians who would be appropriate partners in managing and improving their health.

Certain ACA provisions are specifically designed to encourage health care systems and physicians to collaboratively manage patients throughout the continuum of their health care needs by developing Accountable Care Organizations (ACOs). An ACO enhances care coordination, support in disease management, attention to evidence-based medicine standards and patient experience. Medicare’s healthcare quality measures, which ACOs must meet, “raise the bar” for healthcare delivery and are a benefit to patients.

Hospitals, physicians and other care providers are also improving communication through secure and confidential exchange of patient information through electronic health records (EHRs) and health information exchanges (HIEs).

Through illness and recovery a patient may transition several times from family physician to specialty physician to hospital and perhaps rehabilitation hospital or nursing home. With EHRs and an HIE, critical details about health history, chronic conditions, medications and tests can smoothly transfer from one health care provider to another to improve care efficiency, enhance safety and reduce unnecessary duplication of testing. Patients may also access the HIE, in our region known as the Keystone Health Information Exchange (KeyHIE), to review some test results and care summaries. This additional information transparency is an improvement for patients.

Improving access to care is another important goal of the ACA. To support that goal many primary care providers are expanding hours for non-emergency care. Some are offering evening and weekend hours to improve convenience for patients seeking routine care or treatment for minor ailments.

ACA health insurance provisions direct that 85 percent of every premium dollar be spent on providing actual health care or improving healthcare quality rather than insurance carrier profit.

Additional changes expand insurance coverage of preventive care and health screenings that help detect illness early and decrease complications. For many patients, more screening tests and immunizations are being reimbursed by insurers without patient co-payments.

By legislating mandates to insurers, healt care delivery systems and physicians to provide the best quality care and service available to health care consumers, the ACA is making some positive changes that lead to enhancements in the health security of Americans.

Lopatofsky practices at Susquehanna Health Family Medicine at DuBoistown and is the chief medical officer of Susquehanna Health Medical Group.