With the U.S. Supreme Court ruling in favor of the Patient Protection and Affordable Care Act’s (PPACA) constitutionality, the legal and political debate over healthcare reform is largely over. Full implementation is now. The federal government and the majority of the healthcare community have already begun building the infrastructure and policies necessary to execute and sustain the most significant shift in the delivery of healthcare and the cost-sharing of healthcare services since Medicare. Many PPACA objectives have been achieved1, such as providing access to insurance for uninsured Americans with pre-existing conditions, prescription drug discounts for seniors, and allowing providers to organize as “Accountable Care Organizations” (ACO), which are integrated health systems.
The biggest challenges, however, are still ahead, including: implementation of the insurance mandate for all Americans; establishing effective health insurance exchanges at the state level; developing the business policies around rewarding medical best practices for providers and hospitals; and promoting transparency and choice for patients when evaluating the medical decisions for themselves and their families.
These objectives and many others will require sound and proven business processes that can simplify a highly complex and sensitive function and make it better for every stakeholder – including patients, insurance companies, healthcare providers and the government.
The Challenges of Implementing Healthcare Reform
Improvements in and development of health information technology (IT) that impact both the public and private sector are core to the success of many aspects of PPACA. These programs will make it possible for healthcare providers to better manage patient care through secure use and sharing of health information. This includes programs under the HITECH Act, passed as part of the American Recovery and Reinvestment Act of 2009 and the PPACA, which addresses security and privacy risks around the use of patient health information (PHI).
To implement these provisions, including improvements in healthcare IT, extensive outreach is a must, as is developing effective communication and monitoring large and small businesses in a wide range of private industries. Meanwhile, the risk of operational mistakes that result in reports of fraud, waste and abuse could impact the credibility and timely funding of key provisions of PPACA and related initiatives. Some healthcare-related challenges federal agencies face include:
- HIPAA’s Privacy Rule directly impacts population-based research used to investigate the outcomes of healthcare practices. Federal agencies involved in such research need to ensure they are in compliance with HIPAA guidelines when working with PHI.
- The growth and sophistication of electronic health records (EHR), which must be matched with increasing safeguards that will help protect PHI and ensure compliance with HIPAA. There is no single solution for EHR, which makes sharing data between health systems complex and risky.
- Billions of taxpayer dollars lost annually to Medicare and Medicaid fraud, such as doctors billing for patient services that were never rendered.2
Find out how we can help:
- Healthcare Solutions
- Enterprise Risk Management
- Identity Management and IT Security
1To view the PPACA implantation timeline, visit: http://www.healthcare.gov/law/timeline/
2“Medicare Program,” Government Accountability Office website: http://www.gao.gov/highrisk/risks/insurance/medicare_program.php