Achieving Efficiency and Quality Under ACA

Achieving Efficiency and Quality Under ACA

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A major issue for the U.S. health care system will be accommodating the needs of the estimated thirty-two million Americans who will gain insurance coverage under the Affordable Care Act (ACA) over the next ten years. For hospitals, a traditional response to increased demand might be to add resources, such as more staff and more beds.  However, research has demonstrated that large gains in efficiency can be made through streamlining patient flow and redesigning care processes.  Therefore, business as usual is probably not the best approach as we move into the future of Healthcare Reform.  Fortunately, the ACA lays the groundwork to help support Healthcare IT to foster such change.

Many believe that changes in processes within existing practices can yield efficiencies that will improve access to care by allowing more primary and other care to be delivered from existing resources.  Examples of innovations include streamlined or same-day scheduling (often called open or advanced access) to reduce appointment wait times and streamline operations to reduce overall appointment duration while maintaining or increasing time with clinicians.  For a physician practice even the simplest changes can be a disruption and require full commitment to achieving the desired outcome.  Many of the innovations may require or would work more smoothly with increased services from Healthcare IT.  Not only does the ACA provide guidelines for the standardization of such new process but provides Federal support to States for the purpose of developing new, or adapting existing, Healthcare IT.1

The health care system is made up of many individual practices, subsystems, and institutions, each dependent on many others to achieve desired outcomes. Improvement in the transactions among these components can conserve resources and thus serve more patients.  There could, for example, be a centralization of services into larger group practices so as to combine specialties in a ratio that reflects patient needs.  There will be an increasing need for Healthcare IT to provide secure, reliable and accurate methods for these transactions.  At the Federal level, the ACA provides technical support for interoperability standards; at the State and regional level, it supports development of regional Healthcare IT systems and standards; and at the practice level, it provides capital subsidies and technical assistance for implementation of electronic health records.2

With all of the sweeping changes on the horizon in the Healthcare Industry via the ACA, combined with the need for IT professionals to be a significantly involved in that transformation,  there is going to be an increased demand over the next years and decades for properly trained and highly skilled Healthcare IT professionals to help ensure quality care.3  Among the many provisions in the newly minted Affordable Care Act is the creation of community-based interdisciplinary ‘health teams’ to provide support services to primary care practices within hospital service areas and the establishment of the ‘National Healthcare Workforce Committee’ which will develop education and training programs and disseminate information about policies that affect recruitment and retention of the Healthcare IT workforce.
The expansion of insurance coverage coming soon under the Affordable Care Act will greatly impact the ability of existing systems and institutions to provide good access and quality care to to all of those who will be covered.  At this point the ACA is only a start but even now it provides not only guidelines for how to achieve quality healthcare moving forward but the support and funding required for the Healthcare IT community to play a major role in the transformation and success of the expanded coverage offered by the ACA in the years to come.

1 The Patient Protection and Affordable Care Act - Summary of Key Health Information Technology Provisions
2 Assuring Access to Care under Health Reform
3 U.S. Healthcare Workforce Shortages: HIT Staff

~ Steve Barnes