Time To Focus On The ACA’s Sometimes Unheralded Virtue: Value-Based Care

Lost amidst the coverage of President-Elect Donald Trump’s transition and cabinet appointments is a chilling fact: the lives of Americans are getting shorter. Despite spending more for health care than other high-income countries did in 2013, life expectancy in our country declined between 2014 and 2015. Meanwhile, the president-elect has pledged to repeal the Affordable Care Act (ACA), and Senate Republicans put the wheels in motion, even though the law has resulted in greater health insurance coverage than ever before in our history and has improved access to health care for Americans.

As we consider where to go from here, it’s natural to question if the results of the election were a referendum on health care reform. A deeper question looms as to whether we will make progress on improving health outcomes and reducing individual and societal health care spending, or will we fall back into a state of impasse, division, and debate about basic health care access and financing issues. Most Americans believe that high-quality, affordable health care is something that every one of us deserves. The ACA may not be the perfect or only solution, but beyond major gains in coverage, it has spurred innovations in, and new approaches to, the delivery and payment of health care and provided a platform for the critical work ahead.

Here in California, we’ve learned firsthand how expanding health care coverage to millions more people is a fundamental step in making care more effective, integrated, and patient-centered. Without that first step, other advancements become much more challenging. For those reasons, starting from scratch could have profoundly negative consequences for access to health care for millions of Californians and severely inhibit progress in achieving the Triple Aim of better health outcomes at lower costs with better patient experience.

In recent years, in addition to California’s having extended health care coverage to millions of residents, Blue Shield of California Foundation—in collaboration with other funders and state and local governments—also begun to test and implement new payment models that reward positive outcomes for patients and enhance the quality of care without increasing costs. The foundation has invested in—and continues to support—a variety of approaches that support this shift toward higher value care over rewarding the volume of services provided:

• Technological innovations that make services more patient-centered, convenient, and efficient.
• Alternative financing that allows health care providers the flexibility to give patients the care and unique support that they deserve.
• Core metrics for measuring collective progress and aligning providers, payers, and policy makers on the outcomes that matter the most.
• Local collaborations that connect health and social services to improve health outcomes at the community level.

Regardless of the short-term fate of the ACA, these investments illustrate the important progress we’ve made in reshaping our health care payment and delivery systems for the future. Along the way, we’ve learned valuable lessons about the structural, cultural, and technical hurdles inherent to the process that can help to inform our ongoing efforts and those of others.

This work is not easy, but it is essential. If we’re going to continue our progress from here, we must create a policy environment that supports fundamentally different ways of operating within the health care system and of engaging with other social services that affect people’s health and well-being. We will need to change hearts, minds, and deep-seated practices. We will have to cultivate new relationships and strengthen existing ones.

Inevitably, new challenges will arise along the way, but after more than twenty-five years of working to improve health care, I am convinced that orienting our system to incentivize better health outcomes—for families, individuals, and communities—is the only sustainable, long-term answer.

This blog originally appeared in Health Affairs' Grantwatch Blog on January 12, 2017