By Former Sen. Tom Daschle (D-S.D.) - 12/02/11 12:21 AM EST
The healthcare system — we argue about it, think about it, study it, agonize over it. But, the very name is somewhat misleading. What we have in America today is less a system than a series of disconnected and disparate entities, which struggle to exchange information, leverage best practices and obtain economic efficiencies. But, this is truly a transformative time in healthcare. While the merits of the Affordable Care Act (ACA) continue to be debated, the private sector, largely as a result of the ACA, has begun taking steps to adapt in ways that hold great promise to further the goal of better outcomes at lower costs.
To understand the changes taking place in healthcare, it is important to understand just how fractured our system has traditionally been. Across the country, patients receive care from hundreds of thousands of healthcare practices and tens of thousands of hospitals. Dozens of insurance providers negotiate with hundreds of companies that manufacture healthcare products ranging from medical devices to prescription drugs. And, of course, various government programs, including Medicare and Medicaid, interact with each of these different entities.
So as we think about tackling the big question of how we can improve healthcare quality while simultaneously reducing cost, one important step is addressing information flows.
Over the last year, I’ve had the privilege of talking with innovative companies across the country, from providers to health plans to health information technology vendors. It is easy for the political noise around the healthcare reform law to drown out the fact that these organizations are adapting to new realities in interesting and innovative ways that could improve healthcare and reduce costs. One example is the movement among health plans to make strategic acquisitions that enable them to better leverage access to data and technology, which ultimately drives enhanced quality and more efficient care.
Another example is the proposed merger of Express Scripts, Inc. and Medco Health Solutions, Inc., two leading national pharmaceutical benefits managers (PBMs). By virtue of their scale, access to patient and pricing information, efficient delivery systems and partnerships with networks of retail pharmacies, PBMs are often able to deliver medicines at significant discounts. But, these two companies have taken the traditional PBM model a step further by investing in capabilities to improve patient adherence, a true benefit for patients and the healthcare system. Express Scripts, for example, has developed advanced solutions rooted in behavioral science to give patients incentives to take their medicines as prescribed. Medco has tackled the same challenge by building a robust clinical capacity to support appropriate patient behavior at the disease level.
There are countless other examples of movement among health care companies — providers and vendors alike — that are innovating to successfully accommodate new delivery reforms, facilitate coverage of the millions of newly enrolled individuals, and ensure higher healthcare quality metrics are achieved.
While there are legitimate concerns among policymakers about consolidation in the healthcare industry, and these activities should continue to be properly monitored and scrutinized, it is imperative for us to make sure that organizations have the ability to make necessary adjustments and develop necessary partnerships to flourish in this post-ACA environment. While each of these mergers, and those that will follow, will be scrutinized closely by antitrust authorities, it is imperative that any analysis of the partnerships in the new healthcare landscape take into account the progress these combinations can help deliver. Government must be vigilant about preventing too much power from aggregating into too few hands, but in our current healthcare system, one of the greatest dangers is actually the continued fracturing of the system.
We should enable the private sector to help us realize the promise and goals of the ACA. The promising innovations that I see every day will improve the flow of information across the system, creating more consistent quality care while creating drivers that can push cost down, rather than allowing it to relentlessly rise. We are seeing today a natural first wave of adjustments in response to the ACA. Those organizations and companies that deliver better quality at lower cost will thrive in this new environment. Those that don’t will suffer. But the result will be a healthcare system that truly starts to look like a system that is much more integrated and delivers better patient care. And that will be a benefit to us all, now, and in the future.
Daschle, a former Senate majority leader, is now a senior policy adviser at DLA Piper, whose clients include Medco Health Solutions, Inc.