Here are six ways ACA provisions affected day-to-day operations at IU Health.
1. Momentum toward value-based care. IU Health — the biggest healthcare provider in Indiana with 15 hospitals and 8,700 physicians — began transitioning from a fee-for-service payment model to a value-based delivery model under the ACA. Generally, value-based care aims to reduce healthcare spending by encouraging preventive care and improving population health. Dennis Murphy, IU Health president and CEO, said the trend toward value is likely to continue despite policy changes.
“We’ve got to create more value in healthcare,” Mr. Murphy said in an interview with the NYT following the November presidential election. “That principle, I think, survives.”
The results of value-based healthcare have allowed IU Health to decrease inpatient numbers by 12 percent since 2013 at the system’s two adult hospitals in Indianapolis, according to the report. IU Health is combining the two hospitals to form a $1 billion outpatient-focused facility.
2. Emphasis on quality metrics. Under ACA programs like the Medicare Access and CHIP Reauthorization Act of 2015, government payers reward providers that demonstrate quality health outcomes. The link between clinical quality and financial reimbursement from payers has caused hospital systems like IU Health to emphasize quality metrics more than ever. At IU Health, nearly a fifth of some primary care physicians’ salaries (about $50,000) is tied to quality benchmarks and other performance metrics, according to the report.
3. Care management. Under the ACA, Medicare began setting a bundled price for episodes of care, like joint replacements. At IU Health, paying attention to cost and collaborating with ancillary providers helped the system cut the length of stay for its patients recovering from surgery from 24 days to 12 days in 2016, according to the report.
4. Cost management. Bundled payments and other capitated rate models established under the ACA placed focus on increasing cost-effective care through price management techniques. For example, IU Health instated “value tracker[s]” in its operating rooms that use color to distinguish the cost of surgical products. A green light signals a lower-cost item and a red light identifies higher-cost items, with yellow marking surgical products with prices in the middle.
5. More consolidation. Under the ACA, a combination of decreasing government and commercial payer reimbursement and increasing market competition led to consolidation of smaller services under larger systems with more financial clout. This past October, IU Health followed suit, entering a preliminary agreement with Clinton County to start managing operation of Frankfort (Ind.) Hospital June 1.
6. Consumer-centric care. With more Americans gaining health insurance under the ACA, providers are increasingly tasked with helping patients understand their specific health benefits. This personalization of care caused IU Health to hire more than 150 care facilitators to help patients gain and navigate their health benefits.
For the full NYT report, click here.
