Innovation Interchange Session: Jeff Goldsmith, PhD

Jeff Goldsmith, PhD, healthcare futurist and analyst, says that the Affordable Care Act (ACA) has significantly impacted healthcare policy, in both negative and positive ways. Health reform has been a tough sell—public ignorance about the law is still vast. For instance, 68% of Americans believe that health reform provides a public health plan option, while another 64% incorrectly believe undocumented citizens can get coverage under the ACA, and almost 60% believe that the law cuts Medicare benefits. Beyond misinformation, the Republican resource freeze has hurt health law implementation, glitches have created a “third-world experience” with the online marketplace launch, there has been mixed decision making with state Medicaid program expansion, and there will likely be significant rate increases for individuals and employers who already have insurance.

“I think by the end of 2016, maybe 20 million of the 48 million people who are presently don’t have health insurance will get coverage,” said Dr Goldsmith. “This is progress—it’s 20 million more than nothing, it’s 20 million closer to universal coverage, but it’s still a long way short of where we need to be. The idea that we can still end up with 28 to 30 million Americans that don’t have health insurance— and that’s not counting the possibility of some type of economic downturn in the future—we didn’t get anywhere close to where we need to go with this law.”

Part of the problem with care system and payment system redesign is that there is no consensus; in fact, Dr Goldsmith says there is a “try-everything-at-once mentality.” From Accountable Care Organizations (ACOs) to the Patient-Centered Medical Home, policy experts are looking at various ways to innovate care delivery and payment models. One of the more baffling care models for

Dr Goldsmith is the ACO. He noted his concern was “not a problem with managed care, it’s a problem with how you do it.” He suggested that Medicare Advantage, not ACOs, would be the future of Medicare.

Future payment policy trends will also likely include episode bundling, cost containment in subpopulation health, and simplified payment for clinical services. Dr Goldsmith concluded that the medical community values are changing, and pharmaceutical choices needed to be embedded in that protocol because intelligent and timely use of drugs requires pharmacy participation.