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Health System Management • January 2017

“A complete repeal of the Affordable Care Act will be politically unpopular.” COMMENTARY HEALTH SYSTEM MANAGEMENT | JANUARY | 2017 As we enter the era of the Trump presidency, this is a good time to evaluate our “healthcare system” (quotes intentional). My online dictionary defines a system as “a set of connected things or parts forming a complex whole” or “a set of principles or procedures according to which something is done; an organized scheme or method.” By any definition, our healthcare is not delivered in a system. It is delivered via unconnected and unorganized entities without a common set of principles, procedures or standards. In fact, within a single healthcare provider organization, there may not be much in the way of common principles, procedures, standards or beliefs. Since we really lack a true healthcare system, it should be no surprise that we have a healthcare affordability and accessibility crisis in our country. We continue to spend a bigger percentage of our gross domestic product on healthcare than any other developed country1, yet we still do not have universal access to healthcare. As another symptom of the problem, there is huge geographic variability in healthcare costs across the U.S.2 RECOGNITION OF THE PROBLEM Zig Ziglar said that “the first step in solving a problem is to recognize that it does exist”. So, herein lies some good news: The government recognizes that there is a problem with healthcare costs and delivery in our country, and it BY JERRY HENDERSON Henderson is the Clinicient vice president of Therapist Success THINKSTOCK is working on innovative strategies to address it. The Affordable Care Act (ACA) was designed, in part, to improve access to the healthcare system. And, the ACA has been a partial success in this regard. Twenty million more people have access to healthcare today because of the ACA. But these people are now accessing a healthcare system that is still largely inefficient — and improving inefficient healthcare delivery may prove to be a bigger challenge than improving accessibility. The Center for Medicare and Medicaid Innovation (CMMI)3, which was developed as part of the ACA, has been charged with developing and testing innovative payment and service delivery models with “triple-aim” goals of providing better care, smarter spending and improved overall health. CJR BACKGROUND An example of one initiative working towards this goal is the Comprehensive Care for Joint Healthcare in the Trump Era If bundled payments are the answer, what was the question? 21 WWW.HEALTHSYSTEMMGMT.COM


Health System Management • January 2017
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