How has American healthcare fared since the Affordable Care Act (ACA) was passed? That’s the wide-ranging question that Steven Brill’s new book “America’s Bitter Pill” strives to answer, and Brill’s response is more positive than one might expect.
Brill explores the impact of America’s evolving healthcare system on patients, providers and insurers, including a glimpse into Partners’ own efforts to redesign health care. In his research for the book, Brill spoke with Partners CEO and president Dr. Gary Gottlieb about our 2011 agreement with Blue Cross Blue Shield – a promise to improve quality while lowering costs. Under the agreement, Partners designates a certain amount of money to care for a particular patient population covered by Blue Cross Blue Shield. If Partners provides the care at a lower cost, savings are passed on to us to reinvest in our mission, but only upon meeting certain quality measures.
Brill calls this model “a significant step forward” and attributes its success, in part, to Dr. Gottlieb’s unique perspective. “Unlike conventional healthcare reformers, Gottlieb saw price transparency…as having a downside,” writes Brill. If patients pick and choose where they receive each service, it’s more difficult for the Partners system to balance costly services (like mental health care) with less-costly ones. Dr. Gottlieb told the author:
‘I’ll compete with anyone on cost and quality, if you give me the whole patient… People with hip replacements also have dementia…Someone with heart disease not taking his medication might also be depressed. We want to compete on how well we treat that whole patient.’
Peter Orszag, former director of the Office of Management and Budget (OMB) during President Obama’s first administration, argues that Brill understates the impact of the ACA on healthcare costs. New regulations have forced healthcare organizations to find new, more efficient cost models, he says, like those piloted here at Partners in recent years.
To operate in today’s health care environment, we at Partners believe in treating the whole patient and being held accountable for the entire patient population in our care. Our patients are served in a sophisticated system, and we believe that system functions best when it functions as one.