Top Connecticut Experts Discuss Success of Healthcare Initiative: “We’re Not There Yet—But We’re Making Great Strides”

2015-03-16_aca2When it comes to access to healthcare, Connecticut residents are much better off now than they were prior to the creation of the Affordable Care Act, according to a panel of experts.

But, this new system is still in its infancy and there is still much to be done in order to achieve an ideal healthcare delivery system, they agreed.

The five panelists shared their expertise in a UConn School of Business program titled, “Grading the Affordable Care Act.” The March 4 program drew 75 people to the Graduate Business Learning Center in downtown Hartford.

Panelists included Eric Schultz, president and chief executive officer of Harvard Pilgrim Health Care; Anne Melissa Dowling, acting commissioner of the State of Connecticut Insurance Department; Demian Fontanella, general counsel for the Office of the Healthcare Advocate; Matthew Katz, executive vice president and chief executive officer of the Connecticut State Medical Society, and Jennifer Jackson, president and chief executive officer of the Connecticut Hospital Association. Katharine Lewis, deputy commissioner of public health, served as moderator.

Early in the discussion, Fontanella described a family that was pleased with its high-deductible health insurance policy and was dismayed to have to select an ACA plan with higher premiums. A short time later, a member of that family developed a serious illness, which would have bankrupted them, had they not been covered by the new, more comprehensive policy. That’s just one example of the healthcare program’s success, he said.

The number of people who lack health insurance in Connecticut has been cut in half, from 8- to 4- percent because of the ACA, Dowling noted. Panelists agreed that more Connecticut residents are now benefiting from greater insurance choices,  improvement in hospital safety and a reduction in the number of people using emergency rooms in place of doctors’ offices. The healthcare act has also eliminated denial of coverage based on pre-existing conditions, and expanded opportunities for young adults to remain on their parents’ insurance plans. But Schultz offered perhaps the most compelling argument for the program.

“Making health insurance available to low-and moderate- income families has given them a peace of mind that they never had before,” Schultz said.

Jackson, the head of the hospital association, summed up Connecticut’s healthcare system as a work-in-progress.

“We’re not there yet—but we’re making great strides,” she said. The panelists agreed that Connecticut is the nation’s leader in implementing the plan.

Yet for all the good, there are many shortfalls, they agreed, including a shortage of  primary care doctors to care for these newly insured patients. Many small physician practices feel compelled to partner with hospitals or larger practices because their requirements have become so complex. Issues remain surrounding quality assessment, lingering problems of equity and disparity, inadequate transportation to shuttle the poor to doctor appointments and cyber security issues.

Schultz said while people can more easily compare policies, the industry needs more transparency about hospital and physician quality and costs. Members of the panel acknowledged that it is a challenge to define which, among hundreds of quality assessment tools, should be used as the gold standard for excellence.

During the panel’s question-and-answer period, several people in the audience expressed discontent with the healthcare system, saying that it encumbers medical professionals, restricts their time with patients, and that they view the healthcare industry as highly inefficient.

One man said during a visit to his long-time physician for treatment of a sinus infection, the doctor was uncharacteristically rushed and spent most of his time entering information into a computer. Another speaker said during a recent hospital emergency visit, she was asked the same question 20 times by different clinicians. “I thought, ‘This is the most inefficient system I’ve ever seen,'” she said.

Katz, from the medical association, said many doctors feel like they are being ‘evaluated to death.’ But, he said, there is no excuse for inattention. “If, in adapting to change, we lose sight of the patient, we’ve lost sight of care, and we’ve harmed the system.”

The number of physicians who can—or chose to—remain in small practices has dwindled. In the past, about 15 percent belonged to hospital-owned practices and that number has risen to about 50 percent, with a vast increase in the last 18 months, Katz said. That’s due, in part, to the ACA requirement to install electronic medical records, which can cost up to $75,000, a hefty investment for a small practice.

But Schultz defended the increased use of technology—saying the medical profession lags behind all others in its sophistication—and that in many instances, technology has made a physician’s job easier, because with the click of a button, he or she can send a prescription to a pharmacy.

The use of electronic medical records was designed to provide quick access to detailed health records in case, for instance, a Connecticut resident broke a leg while on vacation in Florida, Fontanella said. But, instead, our country now has a patchwork of systems that don’t communicate with each other.

Because so much data is now stored electronically, cybersecurity is also a growing concern for the medical field. Last year, 179 physicians in Connecticut alone had their data breeched, Katz said. “This only highlights the complexity of protecting valuable medical and financial information,” he said.

The discussion also touched on another important concern for Connecticut healthcare providers, the shortage of primary care physicians.

Because more people now have healthcare, the demand for primary care doctors  has increased. In the last year, only 11 graduates of UConn and Yale medical schools stayed in Connecticut to practice primary care, Katz said.

Katz suggested the state offer incentives, including medical school tuition forgiveness, for primary care physicians who are willing to practice medicine in state. Schultz also agreed that healthcare dollars need to be “shifted back” to primary care, who can promote preventive care that can often stem the need for more expensive specialists.

Lewis concluded the program by reminding the audience and panelists that the Affordable Care Act, while extremely important, is just one “tool” to consider when addressing the overall issue of health and well-being of a community, state and nation. Public health measures and favorable changes in health behaviors are equally important, she said.

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