Citation
http://www.healthcare.gov/law/index.html
The Patient Protection and Affordable Care Act (PPACA but often called the ACA) was signed into law by President Barack Obama on March 23, 2010 after it passed both the House and Senate following 2 years of debate in Congress. On June 28, 2012, the US Supreme Court upheld the constitutionality of many of the most controversial provisions of the law – including the so-called “individual mandate” to purchase health insurance. The goal of the ACA is to improve access to care while lowering the cost of care by expanding the roles for primary care healthcare professionals, including pharmacists. Here’s a list of the top 10 things every ambulatory care pharmacist should know about the ACA:
1. Opening the Umbrella: The law creates a mandate for all Americans to obtain health insurance. Theoretically, more people with insurance means better access to healthcare services … leading to more patients seeking preventive care, resulting in improvements in health, and reducing overall healthcare costs.
2. Welcome Home… the Health Home: The law incorporates the concept of a “Health Home,” where patients received a comprehensive suite of services using a team-based approach, including a care coordinator. Pharmacists will be able to work closely with care coordinators to manage medications.
3. There is No “I” in the Healthcare Team: The care of patients is best when health professionals work in collaboration. The law recognizes pharmacists as a specialist. Using a team-based approach to patient care may help alleviate the increasing shortage of and demand for primary care physicians.
4. Here Today, Gone Tomorrow, but See You Soon: The law stresses that a vital way to improve care and reduce cost is the involvement of pharmacists in care transitions, including hospital discharges. Ambulatory care pharmacists can further enhance care by providing medication management / reconciliation every time a patient transitions from one setting to another.
5. Medications for Less: In recognition of the increased need of medications for chronic illness, the law’s changes in insurance coverage provides for increased access to these medications. Further, there will be increased coverage for preventive treatments such as vaccines and smoking cessation aids. Ambulatory care pharmacists can help patients access and appropriately use of these therapies.
6. Pioneer This: Changes in payment to health systems and providers are designed to reduce the cost of the overall healthcare system. In an attempt to steer away from the fee-for-service model toward a bundled payment system, accountable Care Organizations (with similar structures to what already in exists in many Health Maintenance Organizations) are being formed. This will require all providers of care, including ambulatory care pharmacists, to work closely together with the goal of keeping patients healthy … at the lowest cost.
7. Incentivizing Innovation: The law encourages innovative healthcare delivery for preventative care services by funding research that can find ways to reduce costs, improve health outcomes, and expand access. Innovative services provided by ambulatory care pharmacists will undoubtedly received funding.
8. Protecting Grandma: The law expands Medicare Part D services for the elderly by tasking pharmacists to offer MTM services including an annual medication review, follow-up interventions, quarterly review for high-risk individuals, and transitions in care. Moreover, the law requires that targeted beneficiaries be automatically enrolled (but patients are permitted to opt-out if they want … but who would want to do that?).
9. Tech Support: Increasing the appropriate use of technology in healthcare can lead to improved communication and better outcomes. The law fosters the expanded use of information technology through mechanisms such as the insurance coverage connector and meaningful use of electronic health records.
10. Get on the Primary Care Bus: A greater focus on primary care may (hopefully) lead to decreased hospitalizations … which would reduce overall healthcare costs. The law provides new incentives to expand the number of primary care physicians, nurses, and physician assistants including funding for scholarships and loan repayments. Increasing the number of providers in the primary care work force may likely mean an increased need of ambulatory care pharmacists to join these teams.
What now? Many politicians have stated that they want to repeal the law. Polls will open in November and voters will decide if the ACA remains intake. No matter what happens, one thing is clear: Americans want (and need) a healthcare system that enhances access to care AND reduces overall healthcare cost. Regardless of whether the ACA is repealed or replaced, pharmacists in ambulatory care settings play a vital role on the primary care team and we should advocated for policies that achieve the goals of healthcare reform.
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ACA Summary
Nice work, Anusha.
A key point is that within the spectrum of medication management and cost reduction other health disciplines and administrators (and sometimes pharmacists) tend to focus on formulary management, therapeutic substiution, etc. All good stuff, but within the ACO and other cost reduction models, lots of focus will be on reducing extreme outlier costs for avoidable events. For example, reducing an ADE that may lead to an admission or extend LOS (and blow out the DRG) will be of great value. The excellent work with anticoagulation and reducing bleeding events by pharmacists is certainly a good story. Reducing errors of omission for chronic dx that lead to exacerbations and hosptilizations is another example. Lots of opportunity ahead!
ACA Commentary
Thank you Dr. McNamara for that commentary! As a bullet point under the focus of reducing hospitalizations, I think it is also important to remember that under the ACA and beginning in October of THIS YEAR, CMS will implement reimbursement penalties for potentially preventable Medicare readmissions within 30 days of discharge. This focus will be placed on patients w/ one of three conditions – CHF, acute MI, and pneumonia, but plans are also in play to expand to other disease states, such as COPD, in subsequent years. This will be particularly important for medication reconciliation upon discharge and transitions of care, and I see a huge role for ambulatory care pharmacists in helping to prevent these penalties from occurring.
ACA Summary
Great summary!
An additional aspect of the ACA: As of August 1, 2012, health plans are required to cover preventative services for women with NO cost-sharing. This includes well-woman visits, gestational DM screenings, HPV DNA testing, STI counseling, contraception, breastfeeding support, and domestic violence screening. Free=Better Access!
looking forward to our first steps
Thanks Anusha for the article. I took another read as we are ending the year and near the beginning of the new year and some new aspects of the law. One other drug related issue is the access to BC. This has passed through yet another hurdle this week and has continued to be upheld as a change in coverage insurance will be required to provide their enrollees.