Health Care Reform
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Recently, Rick Baird, Adagio Health President/CEO, sat down to answer a few questions about health care reform and how it could affect Adagio Health.
When do you see health care reform really making a difference?
In Pennsylvania, it will begin to make an initial difference when the state decides to participate with expanded Medicaid eligibility. As one of nine "early expansion states," Pennsylvania is eligible to expand Medicaid enrollment to additional populations whose incomes are below 133% of federal poverty in the coming year. If PA decides not to opt for early expansion, eligibility would follow the federal schedule set to begin in 2014. Regardless of when expanded eligibility commences, it will provide public medical insurance to hundreds of thousands of PA citizens who currently neither have employer-funded coverage, nor are unable to afford commercial coverage, yet whose incomes are currently too high to be eligible for Medicaid. Likewise, with mandatory coverage, those currently without commercial or publicly funded coverage will begin to be financially incentivized to seek coverage in 2014.
A challenge to the health care system is finding enough providers to serve these additional numbers of insured persons, and determining what the most efficient service models are.
How will health care reform affect Adagio Health's service delivery?
Currently, well over half of the 80,000 clients we serve in our direct service site medical offices, and through subcontractor offices, are enrolled in Medicaid. In addition, we serve many thousands of clients with commercial coverage. When health care reform is implemented, we expect more clients to be enrolled in both Medicaid and through commercial insurance than currently. As a result, fewer clients will be in a self-pay cash category, and hopefully more will be able to afford additional care or follow-up treatments that current grant funding sources are unable to cover. We expect an increased demand for our services.
Will it make some funding streams obsolete? Will we still need the support of private donors?
Health care reform probably will not make current funding streams obsolete. For example, we currently receive funding for the Centers for Disease Control and from the Commonwealth of Pennsylvania to provide breast and cervical cancer screening, diagnosis, and treatment services to uninsured or underinsured women with incomes under 250% of federal poverty. Our current funding for these services enables us to provide services to approximately 10% of the eligible women statewide. It is too early to predict whether health care reform will enable 100% of these women to be enrolled in commercial or publicly-funded coverage. I would anticipate that some of these screening and diagnostic funds will be retargeted to provide access to care to populations who remain outside of the wider coverage umbrella provided by health care reform.
We will continue to need the help of private donors. Commercial insurance, Medicaid, and diminishing public grant funding will not be able to keep pace with the need for every more sophisticated diagnostic equipment and testing, ongoing staff training, and other infrastructure needs. We will be challenged to have adequate capacity to serve additional clients, and the fee-for-service nature of the expected reimbursement systems do not adequately underwrite capacity expansion or enhancement.
What new opportunities will health care reform present to Adagio Health? Are there new programs that might develop as a result? Might some programs become unnecessary?
Health care reform should help to enable us to reach populations who currently have no health insurance, and for whom our limited grant funding is inadequate to underwrite. We expect it to drive new partnerships with other types of provider institutions in an effort to offer the most efficient and highest quality delivery system possible.
What do you think health care in general and Adagio Health specifically will look like in 10 years?
I think that in 10 years, a much higher percentage of people will have some sort of basic medical coverage, and that provider organizations will have developed ways to enable clients to access high quality care in a responsible manner. I expect a much higher focus on preventive services in an effort to restrain cost increases, and health incentive packages on both commercial and publicly funded insurance that motivate consumers to take better care of their health when possible. I expect more internet-based health care, with clients reviewing and sharing their own medical charts, getting prescriptions filled through more on-line purchasing associations, and other means of reducing reliance on face-to-face interactions with providers. Finally, I expect there will be many new roles for health care professionals and service organizations whose mission is to assist individuals in navigating through these new system enhancements.
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