As 2016 drew to a close, the political environment in the USA was turbulent. In an atmosphere of disinformation as the norm, establishing clear pathways for the continued evolution of the health care reform efforts instigated by MACRA is proving ever more difficult. We simply don't know what the effects of this sharp political direction change may be, and that only fuels the uncertainty felt in the health care system as a whole.
What we do know however, is that the basic premise of the health care reform movement in the USA is unchanged. The system as it is currently configured is inherently flawed, the net result of those flaws being the double digit increases in health insurance premiums we have been seeing for the last few years. This situation is as unsustainable now as it was in 2016, and so the rationale behind MACRA remains the same too. The House and Senate realized this and backed MACRA in a bipartisan manner. Since then some of the provisions have been enacted and now the implications are beginning to be felt throughout the system. This is the equivalent of the supertanker changing course, but instead of physical momentum taking the ship 10 miles before being able to execute a turn, we have political momentum driving the system forward, but with the course corrections inherent in MACRA slowly turning the system to a new direction. This takes progressive time, unless a tipping point is achieved whereby the desire for change overcomes the threshold level of resistance forces against it. I can feel that tipping point rapidly approaching.
What does this look like at each level in the health care system? Clearly there are some themes that are relatively constant. Costs are increasing, demand is increasing, supply (of qualified providers and associated resources) is decreasing and wages are stagnant. Whichever level you work at, the net result of these factors is increasing pressure to understand your costs, how they arise and how you can reduce them. In a system that has shown little appetite for exposing those costs, this pressure begins to stress the system as a whole. That stress rails against the system constraints, such as politico-economic forces, resulting in decreasing performance, an exodus of trained providers exacerbating the already diminished pool and more patients postponing or neglecting to engage with the system in anything other than catastrophic ways (typically by presenting at the ED).
Systems thinking teaches us to look at the root causes of system conditions and address them to achieve sustained improvements in performance. Identifying and working with organizations to improve these conditions is a core specialty at VPQHC. Email me at firstname.lastname@example.org if you would like to find out how we can assist you to get an understanding of your costs, a plan to improve them and sustained assistance in implementing those plans.