On November 8, 2016, the American people made an historic choice and elected the ultimate outsider as president of the United States: Donald Trump.
President-elect Trump will likely put forth many policies that differ from the Obama administration. This includes healthcare and the Affordable Care Act (ACA), which Mr. Trump has said he would like to repeal and replace with health savings accounts (HSAs).
The overall goal of the ACA is to transform American healthcare from a fee-for-service model to a value-based care model. Ultimately, I do not believe Mr. Trump will so much as overturn and repeal the ACA but rather modify many aspects of what has come to be known as Obamacare.
Today, there are too many care model pilots and initiatives that are showing great results. As a result of Mr. Trumps election there is now confusion in the market place and significant delay in decision-making as many healthcare organizations consider how exactly his administration may alter the ACA. Unfortunately, this will give more time to inefficient providers and payers to continue doing what theyre doing and not implement key changes necessary to move to value-based care.
Overall, I do believe that Trumps administration will redefine the goal of providing insurance coverage and healthcare for all.
President-elect Trumps campaign website also stated that he will:
? Work with Congress to create a patient-centered health care system that promotes choice, quality, and affordability.
? Work with states to establish high-risk pools to ensure access to coverage for individuals who have not maintained continuous coverage.
? Allow people to purchase insurance across state lines, in all 50 states, creating a dynamic market.
? Maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will better serve their low-income citizens.
Mr. Trump will likely have the support of some of the biggest insurance companies, such as Anthem, Cigna, Aetna, Humana, and UnitedHealth, who are requesting changes to the law after losing almost $2 billion this year on the individual market.
There will likely be some concessions made due to lobbying from these poor performing entities. However, we believe that the Centers for Medicare and Medicaid Services (CMS) will continue its focusing on changing its overall payment model, with the expectation that by 2018, 50 percent of all CMS payments will be capitated and 80 percent of these payments will be quality-based. Because of this, its critical that healthcare organizations prepare to meet the expectations and requirements under this changing payment model rather than delay and hope for a more significant change from Trumps administration.
With this in mind, it is very likely that much of what comprises the ACA will become permanent fixtures of healthcare. This means that payers and providers will increasingly be held accountable for positive health outcomes of their members and will be reimbursed based on defined measurements for these results. Today progressive companies have begun to embrace this shift to value-based care and are benefiting financially from this change. While many other healthcare organizations may wait to understand the impact of changes from Trumpcare, the industry overall has begun to shift to a new payment model that is unlikely to change.