Delivery of Care

Fifty-fifty.

Those are the odds given by a prominent Atlanta attorney that the Supreme Court will uphold the 2010 health reform law.

He gives the same odds that the justices will strike down the Affordable Care Act (ACA) in its entirety or part of the law that includes its controversial mandate for most individuals to purchase health insurance.

“The case is truly difficult,’’ said attorney Bruce Brown of McKenna Long & Aldridge, at an Atlanta conference this week held by the Georgia Charitable Care Network, an organization of charity clinics serving the uninsured in the state.

Brown, whose legal experience includes clerking for the late Chief Justice Warren Burger, said he believes the justices ‘‘will really grapple with’’ the complex law.

The court’s decision is likely to come in late June.

The stakes for Georgia and other states are high. The law, if upheld, would extend Medicaid coverage to 650,000 Georgians and private insurance to thousands more. The state’s current rate of uninsured is 20 percent, one of the highest percentages in the nation.

And a new study shows access to health care is a big problem in Georgia.

Adults in nearly every state saw their access to health services worsen during over the past decade, with Tennessee, Florida and Georgia having the greatest increase in people reporting having an unmet medical need, according to a study released Tuesday. full story

A task force working with state officials on restructuring Medicaid has given rise to a new group — one that’s specifically concerned with mental health and substance abuse issues.

Members of the new group say it offers them an unusual opportunity to help shape requirements for what is likely to be a huge state health care contract.

“It seems like an opportunity to take a public health approach [to] substance abuse and mental health,’’ says Neil Kaltenecker, executive director of Georgia Council on Substance Abuse. She’s a member of the new panel.

The state is contemplating a whole new structure for Medicaid and PeachCare. The Department of Community Health is working on a ‘‘redesign’’ of how the two government insurance programs are run. The process has drawn intense interest from stakeholders, policymakers and health insurance companies expected to bid on contracts. full story

Five Georgia community health centers will receive a total of $11 million in grants to expand and improve their services, the federal government announced Tuesday.

The Georgia money is part of $728 million nationally that will go to hundreds of community health centers across the country, under the 2010 health reform law.

A Stone Mountain health center highlighted in a recent Kaiser Health News article for scoring poorly on six care measures will get the largest amount awarded in Georgia. Oakhurst Medical Centers will receive $5 million to construct a larger facility.

Jeffrey Taylor, Oakhurst’s CEO, said the building will be in a more visible location, on Memorial Drive. “People now drive by our [current] facility and head to Grady’s emergency room,’’ Taylor told GHN. “They don’t know we’re there.’’

The new Oakhurst building will serve more people and provide more wellness activities, he said. Taylor said he believes it will help improve the center’s care. Many of the health center’s patients are refugees who have not had regular medical care, including children who have not received vaccinations.

The second-highest grant in Georgia is $4.9 million to the Neighborhood Improvement Project for a new building in south Augusta. full story

The future of primary care can look downright frightening.

Georgia and the rest of the nation already have a general shortage of obstetricians, internists, pediatricians and family medicine doctors, especially in rural and urban areas. And things are getting worse. The Health Resources and Services Administration forecasts a shortage of 65,000 primary care physicians in the U.S. in 2020.

Meanwhile, most physicians coming out of medical school are gravitating toward specialty medicine instead of front-line care.

If the Affordable Care Act is upheld by the Supreme Court, the law will enable 30 million uninsured Americans to gain coverage. A common prediction is that many of those newly insured people will immediately seek the physician services they have long needed, swamping primary care practices.

Currently, on the other hand, many uninsured patients put off seeking care until ‘‘the pain is unbearable,’’ said Dr. David Satcher, director of the Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta.

Satcher, a former U.S. surgeon general and CDC director, joined a panel that addressed the future of primary care last week in Atlanta at the Association of Health Care Journalists conference.

The experts’ presentations suggested there may be no single answer to the nation’s primary care problem, but rather a number of partial remedies that, taken together, may fill in some of these vexing gaps in our health care system. full story

The ‘‘good old days’’ of health care are disappearing -– if they’re not gone already.

Those were the days of consumers going anywhere they wanted to get medical care, and not paying any attention to the price, or to their state of ‘‘wellness.’’

And the days of doctors and hospitals charging an extremely high price for services, and not paying close attention to the quality of their care, are also fading.

The new landscape in health care was dissected by a panel of experts at a Wednesday symposium in Atlanta sponsored by Buck Consultants, along with Blue Cross and Blue Shield of Georgia, Healthcare 21 Business Coalition, and Piedmont Healthcare.

Rising costs have helped propel this whirlwind of change.

Employers that offer health insurance are feeling the pinch of these costs –- and are, in turn, squeezing workers for more out-of-pocket payments. Medical providers are battling increased costs of their own, and at the same time are being pressured on pricing and quality from insurers and employers.

And health care reform, though its own fate remains uncertain, has jump-started the trend toward revamping the health care payment system, so the value of services gets rewarded — not the volume of services delivered.

“It’s all changing,’’ said Piedmont CEO Tim Stack, one of the panelists. “It’s not going back.’’ full story