ACA is necessary, but not always easy

More than a half-million Michigan residents have registered for healthcare coverage through healthcare.gov. Thanks to the Patient Protection and Affordable Care Act (ACA), they are able to see a doctor at an affordable cost, regardless of pre-existing conditions. Yet, as a nation, we are at risk of reversing this monumental step should the U.S. Supreme Court rule in the King v. Burwell case that tax subsidies for federally operated state exchanges are not supported by the law.

As a practicing primary care physician in the state of Michigan for 26 years, I have seen patients from all walks of life who have received varying levels of healthcare. With the help of the ACA and Healthy Michigan, the expansion of the state’s Medicaid program, it is clear that many of my new patients, some of whom have serious medical conditions, are seeing a doctor for the first time in years. Most likely, these patients have been receiving medical care through an emergency room.

{mosads}Within my practice at St. John Providence in Detroit – a member of Ascension, the nation’s largest Catholic and non-profit health system – my work is steeped in the Ascension Mission of delivering person-centered care to all with special attention to those who are poor and vulnerable. My focus is to provide all patients with information and counseling on preventive care, while also treating them for conditions that impact their health and their daily lives.

However, many of my new patients through Healthy Michigan are hearing preventive health messages for the first time through our initial office visit. Opening a dialogue with patients is so critical, and continuing the conversation is imperative. My goal is to develop an improvement plan with each individual to ensure sustainable care and improved health and well-being.

We know that the ACA isn’t perfect. Many newer patients haven’t been properly educated about the different kinds of plans available to them, and therefore end up selecting what seems to be the cheapest option with the highest deductibles. The problem with these types of plans is that individuals with chronic health issues are not able to see a physician as often as necessary. Sufficient educational programs about healthcare options are essential to positioning patients in the appropriate plan.

We must work together, providers and payers, to give every person access to the care they need. In the future, this will mean focusing even more intently on care outside of the hospital and doctor’s office. An example is the Integrating Health Into the Home or INH2 program, which is funded by a grant from the Centers for Medicare & Medicaid Services and Ascension. As part of the INH2 program, my practice was able to send a nurse practitioner, nurse and social worker to the homes of patients who were deemed to be at the highest risk for hospital readmissions.

A total of 129 patients have been enrolled in this program, and it has had an over 97 percent success rate in reducing readmissions. Through this program, we were able to review an individual’s life circumstances and uncover problems that may not have been found in an office or hospital setting. Due to the success of this grant, Blue Cross Blue Shield of Michigan is working with providers to institute a similar program. This is the future of accessible and quality care.

While we still have much work to do to improve our nation’s healthcare system, removing the subsidies would be a giant step backward for our society. If patients cannot afford insurance and are not able to buy policies in the future, we risk going back to treating those patients in emergency rooms, at greater overall cost to the system and reduced quality of life for our fellow citizens.

Buccalo is the chief medical officer of St. John Providence Partners In Care, a member of Ascension, and a practicing physician at River Park Health and Wellness Medical Group in Utica, Michigan.