The new health care — for better or worse

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.’’

Medical providers

Providers have scrambled recently to form ‘‘accountable care organizations’’ — groupings of hospitals and doctors that seek to coordinate medical services for patients.

By forming these organizations, health systems are showing they take the demand for change seriously, said Jerry Burgess, president and CEO of the Healthcare 21 Business Coalition.

Stack said Piedmont is working on improving coordination of patient care. Medical care is still fragmented, Stack said. “It truly is not being done in the best way.’’

Piedmont has formed an accountable care organization. The goal, he said, is ‘‘to take care of patients the best way we can.’’

“We’re going to compete against everyone,’’ Stack added. “We want to be the best.’’

Hospital systems, meanwhile, are consolidating at a rapid pace. Dr. Ira Horowitz of Emory University School of Medicine said the metro Atlanta market could end up with four or five large hospital systems at the end of this wave of mergers and new partnerships.


Companies that provide insurance to employees are focusing more on the health of their workforce, the panelists said.

Dr. William Yang, a health management physician for the Coca-Cola Co., said there is much more emphasis on wellness and health promotion.

The panelists said employers will continue to provide financial incentives for workers to improve their health, and in some cases will use higher surcharges to penalize workers for unhealthy practices such as smoking.

Burgess said one Las Vegas employer, by offering a hefty financial incentive, induced more than 90 percent of its employees to switch to a new set of primary care physicians.

Employers are also charging workers more for brand-name prescriptions when a generic drug is available.

Health insurers

Insurance companies will also focus on improving their clients’ health, said Morgan Kendrick, president of Blue Cross of Georgia.

He cited WellPoint, parent company of Blue Cross, which is paying more to primary care physicians who operate a ‘‘medical home’’ for patients. That means one doctor coordinates services for all the patient’s needs, including managing chronic diseases.

Other insurers, including Aetna and UnitedHealthcare, have launched similar medical home programs.

Kendrick also cited a Blue Cross program to steer patients to lower-cost imaging services. Here’s a GHN article this week on the company’s imaging initiative.


How will all these changes affect consumers?

The panelists said patients will have stronger financial incentives to get the care that’s appropriate for them. They will have ‘‘more skin in the game,’’ Horowitz said.

“The patient has to have different expectations,’’ he said.

On the practical end, patients will get regular reminders about physicals, using pharmaceuticals properly and keeping their medical appointments.

If a patient stops using a necessary medication, Yang said, ‘‘no one wins.’’

How do you feel about these changes in health care? Give us your comments below.