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Unknown Consequences May Ride On Affordable Care Act’s Roll-Out

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

Unknown Consequences May Ride On Affordable Care Act’s Roll-Out

Our cover story talks about private-label health plans in which Aetna offers large providers stake in the insurance side of the business. Aetna — and other health plans that might try this — hopes that working with the dominant local provider in an area will increase market share in places where they’re either running behind or out of the running.

I suspect this to be one of the early ripples before a tsunami of unforeseen consequences — both good and bad — of the Affordable Care Act.

A private-label health plan offers an alternative formula for competition to providers who do not want to join an accountable care organization (ACO), whether for operational or financial reasons. It comes down to this: Cost-cutting is not a growth strategy for hospitals, but becoming a plan sponsor might be a way to come to terms with the new methods of payment.

And some of our ideas about where to cut costs may be wrong.

A study in the Journal of the American Medical Association last month notes that trying to avoid emergency department care for the costliest Medicare patients by treating them in physicians’ offices instead won’t save as much as some experts had hoped.

Karen Joynt, MD, MPH, the lead author, tells Reuters Health, “It’s a more complicated problem than we thought.” But isn’t it always.

Answers to such vexing dilemmas might be found anywhere, maybe even across the vast Atlantic Ocean. Which brings us to our new department The Wider View. Our man in London (I always wanted to say that), Robert Royce, PhD, will report on how health care fares in the old world. Or doesn’t fare, as the case may be. Now an independent consultant, Robert has had a strong career in health care in the United Kingdom, most recently as director of strategy at Barking, Havering and Redbridge University NHS Trust in greater London.