This year’s ANI in Orlando was quite an experience! It was wonderful to connect with so many HFMA members and to get a real on-the-ground feeling for the pulse of our industry.


HFMA announced several important initiatives at this ANI—including the Patient Financial Interactions best practices public comments period, which address some of the most pressing issues facing our industry. However, I am mindful that even as we rise to meet challenges in exciting new ways, some deeper issues remain unaddressed.

A number of important decisions are being considered right now: How should our system be organized? Do we allow consolidation to promote care coordination? How do we change the payment system to encourage value over volume? In short, we need to decide who is primarily responsible for improving the health status of the population—healthcare professionals or the people themselves. The old model of very low out-of-pocket costs and unlimited access to health care just will not work economically. We’ve proven that. Now, as legislated and market-based healthcare reform is taking shape, we—as an industry, but also as a society—need to figure out what type of system we want.

As I see it, the defining factor is patient choice. One option is a system involving less choice for patients: A certain amount of health care would be a right for all, limited by economic boundaries including rationing of what care is provided, depending on age and condition. Under this option, out-of-pocket costs could remain relatively low. However, this option would likely create a two-tier system in which well-to-do individuals would access additional health care in a private setting. 

Another option involves more patient choice and more economic stake in healthcare decisions, with patients able to choose which health plan they want and with patients’ lifestyle choices influencing not only their health status, but also their out-of-pocket costs. This option might create difficult situations where consumers have the option to buy high-deductible plans but end up being unable to pay their share. 

Both of these options have potential problems. Creating a two-tiered system means that wealthier individuals will be getting additional care in a second tier of services targeted specifically to their needs and wants. This occurs today in countries that have a “single payer” system. At the other end of the spectrum, people may choose health plans with high deductibles they can’t afford. When they seek care, will healthcare organizations be excoriated for going after people who owe money because of bad decisions? Both options require better collecting and sharing of data across the care continuum, allowing better management of chronic conditions. 

When people make decisions about insurance coverage—either in the exchange marketplace or with employer-sponsored plans—they now must consider risk. The question is, to what degree? Nobody knows yet. This is new territory. 

Certainly, there are political aspects to this dialogue—and, quite frankly, I’m not going there—but I believe it goes beyond partisan politics. Both sides can agree that we need to do something, and that the current environment is not sustainable. Sooner rather than later, we’re going to have to make some sort of decision. We’ve pretty well established what kind of system we can’t have. Now we need to start thinking seriously about what kind of system we can have.

Publication Date: Thursday, August 01, 2013

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