More insured under ACA but price still debated

OPEN DIALOUGE: From left: CharterCare President and CEO Lester Schindel, Blue Cross & Blue Shield of Rhode Island Chief Medical Officer Dr. Gus Manocchia, Care New England Chief Operating Officer Sandra Coletta and MinuteClinic President Dr. Andrew Sussman on a panel at last month's Summit on Health Care Reform & The Insurance Exchange. / PBN PHOTO/RUPERT WHITELEY
OPEN DIALOUGE: From left: CharterCare President and CEO Lester Schindel, Blue Cross & Blue Shield of Rhode Island Chief Medical Officer Dr. Gus Manocchia, Care New England Chief Operating Officer Sandra Coletta and MinuteClinic President Dr. Andrew Sussman on a panel at last month's Summit on Health Care Reform & The Insurance Exchange. / PBN PHOTO/RUPERT WHITELEY

Federal health care reform set in motion a complex wave of changes in how health insurance is provided, paid for and acquired by consumers. Five years into the federal law, often called Obamacare, employers, health care providers and businesses continue to assess its consequences.

The implications of the law in Rhode Island were discussed at length recently at The Providence Business News Summit on Health Care Reform & The Insurance Exchange. The forum drew more than 300 attendees Feb. 26 to the Crowne Plaza Providence-Warwick.

The first of two panel discussions focused on the landmark health insurance reform act, including its impacts on businesses and hospitals, implications for retail medical clinics and whether the newly insured understand what they’re buying on the new exchanges.

Panelists included: Lester Schindel, president and CEO of CharterCare Health Partners; Dr. Gus Manocchia, senior vice president and chief medical officer for Blue Cross & Blue Shield of Rhode Island; Sandra Coletta, chief operating officer of Care New England; Dr. Andrew Sussman, president of MinuteClinic, and executive vice president and associate chief medical officer for CVS Health; and William O’Gara, partner and co-founder of the regional law firm Pannone, Lopes, Devereaux & West, who leads the firm’s employment law team.

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Panelists agreed the implications of the now 5-year-old law are evolving, but had different takes on whether it has led to lower costs in health care, for the insured or for employers.

O’Gara referred to the initial expectation that health care reform would lead to a savings for families on annual premiums of up to $2,500. “If there was supposed to be a $2,500 savings, that savings has been hidden some place. It has not, at least at this point, led to any real reduction in the cost of coverage.”

Mannochia, who before joining Blue Cross was a primary care physician, said the cost of health care coverage is defined by two factors, the price paid for the services, and the volume of services. In response to costs being lowered on the first, he said, providers have increased the volume of services.

“The effect of all that activity is it has created a lot of animosity between the payers and the providers of services,” he said.

The law has had little impact on health care costs, he said. The regulations inherent in the law have made it difficult for service providers to control costs, he said.

To control costs, he said, Blue Cross has a new program in place that is focused on coordinating care for its Medicare Advantage population, in which 10 percent of the enrollees account for half of all program costs.

Coletta, whose system runs four hospitals in Rhode Island, including Kent Hospital and Women & Infants Hopsital, disagreed with Mannochia about the impact of the law. It’s had a dramatic effect in raising the cost of care for hospitals, she said, although as a result it has inspired more collaboration among hospital systems to try to manage those costs.

She also questioned whether Obamacare had resulted in a ramp-up of procedures or services on the part of health care providers. “I am confident in telling you it is the small minority of caregivers,” Coletta said. “They are not providing useless services to maximize [payments].”

The law, all agreed, has led to large numbers of newly insured Rhode Islanders. Since the law began, the figure is about 90,000 people, two-thirds of which are enrolled in Medicaid, according to Peter Marino, president and CEO of Neighborhood Health Plan.

Coletta said one of the effects of the Affordable Care Act is a popular misconception that “hospitals are rolling in the dough” because of all the new people with insurance. The providers agreed to lowered reimbursements, she said, understanding that more people would have insured access to services.

What has happened, she said, is the amount collected in revenue has not offset the cost of the services provided. The newly insured under Obamacare often are in need of multiple services.

In Medicaid, the reimbursement for providers is less than the actual costs, she said. Increasing the volume of a service that has a net loss, “is not a really great financial idea,” Coletta said.

The panelists had differing viewpoints on high copays and deductible amounts – which are a feature of some of the plans offered on the public exchanges, as well as those offered by employers – and whether they deter people with insurance from accessing health care services.

Coletta argued they are having that impact. If someone has a $5,000 deductible, and a minimum-wage job, she said, they will seek out care only in a crisis.

More education is needed when employees or consumers sign up for health care packages, she said.

Hospitals all have experiences, she said, with people paying $10 a month on bills of $10,000. “Most of us do not want to stiff the hospital. When you give them these kinds of copays, they cannot handle it.”

Schindel, of CharterCare Health Partners, which runs Roger Williams Medical Center, Our Lady of Fatima Hospital and affiliated physician and health-provider entities, said coordinated care for patients is the focus. “We really have to focus on the cost of chronic-care management,” he said.

Sussman, of MinuteClinic, which has expanded its clinical services and added 200 clinics across the U.S. since 2011, said the company is focused on providing access to health care services for reasonable prices. Several trends are shaping the demand for services in Rhode Island and across the country.

The nation has an aging population, which will become clearer over the next 20 years, he said, as the baby boomer population ages. There is an epidemic of chronic disease, half of it attributable to obesity. There is an ongoing shortage of primary care physicians, he said. “A lot of people either don’t have a primary care physician or can’t get in to see one.”

In that environment, he said, the no-appointment, evening-and-weekend hours appeal of MinuteClinic has fueled demand among consumers. The clinics are staffed with a nurse practitioner, who can provide services such as checking temperature, blood sugar, blood pressure and administering flu shots and vaccines. In Rhode Island, MinuteClinic has a relationship with Lifespan, the hospital network that includes Rhode Island Hospital.

If a customer needs a primary care physician, the MinuteClinic nurse practitioner can give them a list of local primary care physicians who are taking new patients, Sussman said.

“Health care is no longer one on one,” he said, but a team of providers working with patients. •

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