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Health Plans Must Stay Nimble As Daunting Challenges Mount

MANAGED CARE December 2013. © MediMedia USA
Editor’s Memo

Health Plans Must Stay Nimble As Daunting Challenges Mount

John Marcille

For the thankful parents who are able to keep their young adult child on their health plan, as well as for the millions who are angry at having had their coverage terminated, there is no ignoring the Affordable Care Act.

Opponents vow to repeal; supporters say, It’s the law, deal. Health insurers too have to deal with the ACA and the many challenges it presents. In our cover story, senior contributing editor Michael D. Dalzell does a wonderful job of explaining how the health system isn’t prepared to treat all of the HIV patients who are moving into Medicaid and commercial plans.

The article kicks off with an anecdote about a patient being moved into a Medicaid plan in which his assigned primary care physician seems to put most of his effort into selling a weight-loss product and whose paper handouts contain ads for a pizzeria.

ACA supporters can take heart that a rough launch does not necessarily mean a crash landing. David J. Brailer, MD, PhD, was the health technology “czar” under President George W. Bush. Brailer, the subject of our Q&A, was charged in 2004 with the daunting task putting every patient’s information into an electronic health record.

“No one then would have guessed how far we’ve come,” he recalls. “We have seen very little partisan bickering, and I think that in part is why it has moved forward so well.”

Our stories about quality-adjusted life-years (QALYs) and next-generation sequencing point to further methodological and clinical advances. They are not just about the bottom line. They are about quality of care and of life. These are profound issues that touch everyone, and with which health plan clinicians must forge some sort of accommodation with patients and providers, not to mention the federal government.

Things are moving fast and we’ll be there to keep you up to date.