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My friend Paul Grundy has begun a blog on the IBM website, found here. In his first installment, he details the events of why, in part,  I am more optimistic about the future of American healthcare for having worked with him. In the first part of his entry, he identifies why IBM has more than an intellectual interest in health care:

With this information, [Watson, the IBM supercomputer] can suggest options targeted to a patient’s circumstances. This is an example of technology that can help physicians and nurses identify the most effective courses of treatment for their patients. And fast: in less than 3 seconds Watson can sift through the equivalent of about 200 million pages, evaluate the information, and provide precise responses. With medical information doubling every 5 years, advanced health analytic systems technologies can help improve patient care through the delivery of up- to-date, evidence-based health care.

The point he makes following this, though, is not that the computer will lead to a reduction in health costs by decreasing the need for human interaction. This data needs to be converted to actionable information. That is where IBM, the company that purchases health care, has taken the lead:

So, how to make sure this actionable information flows and is held accountable at the level of a healing relationship?With this question in mind, in 2006, IBM – as a buyer of care- hosted a meeting for 47 of the Fortune 100 buyers, TRICARE, the federal Office of Personnel Management (OPM), buyers and the whole house of primary care. They agreed to guidelines now known as the Joint Principles of the Patient Centered Medical Home (PCMH).

This is how the Patient Centered Primary Care Collaborative got its start.From this group came many of the elements of care transformation included in the Affordable Care Act.

As you can see, Paul and IBM have influenced healthcare for the better and will continue to do so. If you have an interest in policy, specifically where its going as opposed to where it has been, I would advise you to pay attention to his thoughts.

I was at a meeting yesterday with several folks from IBM who were talking about health care. They gave a very good presentation about where health care was going in light of the Affordable Care Act and other policy changes that have occurred. One of the health care executives (from another system here in Mobile) challenged the speaker with what has been the Alabama response:

“Why should we respond to this? When managed care came in the 1990s we were told that capitation would sweep Mobile. It is 2011 and what is our capitation rate? 0%.

“If we just wait it out, this will pass as well. What’s more, the law is likely to be overturned or repealed anyway.”

“Our money’s on Blue Cross”

The response from the speaker was comforting ot those of us who are unhappy with the status quo:

  • The expansion of coverage to adults is already happening. Young adults up to age 26 are now offered coverage on their parents insurance and the vast majority have taken it (thus eliminating 30% of the uninsured). Coming in 2014:

The ACA adds a new category of Medicaid eligibles:  adults under 65 with modified adjusted gross household income (MAGI) at or below 133 percent of poverty.  (Actually, since 5 percent of income is disregarded under the statute, the eligibility level is effectively 138 percent of poverty).  State Medicaid programs will receive 100 percent federal funding for newly eligible enrollees in this category for 2014, 2015, and 2016, gradually phasing down to 90 percent for 2020 and thereafter.  (States that already cover enrollees in this group will gradually receive increased federal funding beginning in 2014 that will reach the same level by 2019).  States may also expand eligibility for adults beyond this limit with their regular federal Medicaid match.

The feds make the rules for Medicaid. As Texas found out, opting out of Medicaid isn’t an option.

  • The insurance market is changed forever. Instead of companies taking a health care hit every year from the insurance companies, the combination of community rating and clearly defined benefits will allow companies to offer a health care benefit that is a defined contribution and takes the risk off of the company. This is already happening in Kansas City

…the Blue exchange is built on a defined contribution model in which employers will give employees a set contribution toward their health insurance and the employees will be able to choose among the available Blue plans. Participating employers will have the option to limit the number of plans available for their employees’ choice or allow them to choose among all 10 options, he said. “This is the consumer-directed health plan model in terms of the consumers having more choices to decide how to spend their health care dollars,” Rowe said. “As a defined contribution model rather than a defined benefit model, it’s like what has happened with pension plans.”

Turns out that Blue Cross is going to have competition

  • Technology is changing everything. This is why IBM is at the table. Data will allow consumers and purchasers to make better informed choices. They have even put together a video showing how data will facilitate these changes whether or not the ACA remains law.

As I was reminded last night, the main provision of Clinton’s health reform package, children need coverage, remained as a legacy even after “Hillarycare” was a distant memory. I think we know what is going to happen. I suspect Blue Cross of Alabama does as well.

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