Will 2014 be a year of momentous change for the healthcare sector? The pieces are certainly in place to make it a transformative 12 months, from Obamacare and Medicaid expansion to accountable care organizations and the Medicaid comprehensive waiver.
But it’s not just blockbuster policies that may alter the healthcare landscape. Drug abuse legislation, palliative care, and hospital consolidation are all poised to help drive change.
The place to start is with the health insurance marketplace and Medicaid eligibility expansion — two centerpieces of the Affordable Care Act that went into effect January 1.
For the next three months, advocates for expanding access to healthcare will be pushing to enroll as many residents as possible before the marketplace’s open enrollment period ends on March 31.
And enrolling low-income residents newly eligible for Medicaid will be an important step for the federally qualified health centers that frequently serve as their primary care providers. The eligibility expansion also is important for hospitals, which are facing the potential loss of federal payments for charity care in the future.
Throughout the year, health insurers will be working to shift residents and small businesses currently enrolled in insurance plans that don’t comply with the ACA — and which are being cancelled — into ACA-compliant plans.
Joel Cantor, director of the Rutgers Center for State Health Policy, said ensuring that these residents and businesses have a smooth transition will be a key issue to assess this year, and could provide lessons that will make enrolling residents in the marketplace a better experience in future years.
The Medicaid comprehensive waiver is changing how long-term care is provided and paid for. Instead of paying for each service separately, insurers are paid to manage all of a patient’s long-term healthcare needs. This managed-care approach aims to provide more services in residents’ homes and in community-based centers, and the waiver will give insurers more flexibility to do so.
During last spring’s state budget hearings, state Human Services Commissioner Jennifer Velez said that the state was planning to have residents living in nursing homes move to managed care by July 2014.
Cantor described 2014 as a “huge transition year” for these long-term-care residents, noting that they are a population with extensive healthcare needs, presenting a substantial policy challenge to state officials.
Another Medicaid program that’s expected to launch this year is the ACO demonstration project. This initiative is intended to increase the coordination of care in low-income areas through ACOs. In an ACO, providers are held accountable for the quality and cost of the care they provide, generally by receiving some of their compensation based on whether they meet quality and cost standards.
Whether the project succeeds or not will largely depend on the ability of the ACOs to address the needs of those patients who use healthcare services the most, particularly those with chronic conditions like diabetes and congestive heart failure. Organizations in Camden, Newark, and Trenton are expected to apply for the program.
While it’s not clear which legislative debates will take center stage in the coming year, a leading candidate is an attempt to reduce the misuse of prescription drugs. In addition, a taskforce on heroin and other drug use by young people, which was formed by the Governor’s Council on Alcoholism and Drug Abuse, is due to release its recommendations. Sen. Joseph F. Vitale (D-Middlesex) also wants to focus on the issue.
One policy proposal that emerged last year — whether to allow physician-assisted suicide — has been met by opposition from Gov. Chris Christie. Cantor said the focus on the issue puts a highlight on a broader problem with residents facing chronic pain.
“Until the healthcare system does everything it’s capable of doing to control people’s symptoms and pain, we may be focusing on the wrong problem,” Cantor said.
This broader policy debate involves palliative care — care that focuses on addressing patients’ symptoms rather than curing diseases.
Nursing homes and hospitals have an opportunity to involve their doctors and patients in making decisions about what steps they want taken to relieve pain in the last stages of life through the practitioner order for life-sustaining treatment, or POLST, form. This form — which has the force of a doctor’s order — was introduced in February 2013, but 2014 may be a crucial year in its adoption.
Cantor said this is an important discussion for New Jersey, which has led the country in providing care to patients in the last months of their lives, without producing outcomes that justify the costs. “They’re seeing each body part attended to separately, but who’s tending to the whole patient?” Cantor said.
Cantor added that hospital consolidation is another ongoing development in healthcare with policy implications that could advance in the next 12 months. Policymakers must keep an eye on whether increasingly powerful healthcare systems gain the upper hand in negotiations to raise the cost of providing care.