Pat Geraghty on the ACA Marketplaces and Effects of Drug Pricing

Introduction:  

Healthcare needs to be viewed from a local lens. Just a few miles of distance can change the reality of patient needs and care dynamics significantly. Applying a local strategy towards caregiving can bring in a competitive edge that remains distinct to the healthcare organization. It allows health clinics and providers to understand and offer care delivery at an intimate level. A deep understanding of the needs of the community, the cultural norms, and ethnic makeup allows meaningful engagement and caregiving at a deeper level, which is bound to multiply patient satisfaction intensely. In a nutshell, cultural relevance is the cornerstone of healthcare.   

 The ACA Bill:  

 When the ACA bill was passed, there was plenty of resistance from healthcare CXOs. Comprehending the bill in its entirety is the first step toward acceptance. The ACA bill is complicated, and healthcare organizations must analyze how to position their organization toward the undertaking. The next step to success is to gain a deep understanding of the needs of the people in the community. This could be done through groundwork with churches and other community-based organizations. Building accessibility through retail centers has displayed immense success. Along the way, how caregiving is viewed begins to evolve through active engagement with the community. The key is to adopt a customer-oriented approach and offer the best customer service possible.   

ACA – A Tool Against COVID:  

Despite its limitations, the ACA bill was considered a safety net for people during the pandemic. Without the coverage provided through the ACA, a large number of ‘at-risk’ individuals would have been without coverage. However, there are certain ways in which the bill can be improvised. For example, adjusting the age criteria to roll in a healthier and younger population health as part of the pool will reduce the premium for older people.   

 Navigating through the unpredictability that came with COVID-19 was challenging as well. The community’s needs versus the federal regulations were a balance that was quite difficult to strike with a virus that needed to be more well-known and predictable. During the first year of the pandemic, the virus’s complications created a situation where caregiving services were greatly reduced. However, the realization of the needs of the community brought on efforts to cut premiums and extend credit as much as possible. As the community realizes caregiving is sincere, educational efforts are also positively impacted. From mask-wearing to social distancing and, finally, to vaccine acceptance, all phases of population education needed to be positively accepted.   

The Role of Home Care:  

 During COVID, home care and telehealth saw an exponential rise. At-home services were expanded like never before. Healthcare services, even for the critically ill, are now being offered at home. Combining technology that allows clinicians into the home setting has created a healthcare movement harnessed by integrating behavioral and physical health. Healthcare organizations that stay on top of this movement will remain ahead of the curve.   

Mental Health – The Need of the Hour:  

Being in the middle of a mental health crisis, education and awareness are critical to success. Primary care delivery must be seamlessly integrated with the behavioral health space to catch mental health illnesses during the early phases. Therefore, Primary care physicians must be educated on the information and signs to see behavioral health needs proactively.   

In the current times, another big challenge is the lack of accessibility to mental health professionals. Applying technology to extend mental health provider’s time and effort within the community is a much-needed solution. Virtual behavioral health should be generously embedded within health plans. Commonly, primary care physicians, without any background in psychiatry or behavioral care, end up being the most common prescribers of mental health medications. Educating and integrating these providers, therefore, can go a long way.   

This will require restructuring the entire healthcare system, wherein primary care providers need to be supported by a team of extenders. Ranging from community health workers and nurses to pharmacists, the primary care continuum needs to be built to have multiple entities engaged in the system. The whole concept of caregiving and disease prevention needs to be reinvented.   

Drug Pricing:  

 Drug pricing has been a long-standing issue. The healthcare industry has long not allowed negotiation within the Medicare program. Pharmaceutical pricing must undergo a certain amount of change around negotiation, and there is no room for delay.   

 Inefficient and outdated pharmacy systems make it challenging to manage inventory and create a vulnerability to errors. Manually keeping up with constantly updated changes in policies and procedures in real-time is unmanageable. Difficulty managing audits is owed to traditional legacy systems that do not offer innovative and automated processes.   

Outdated systems make tracking the dispensing and replenishing of medicine challenging, disrupting the process’s smooth functioning.   

Through supply chain optimization, a solution can be designed and developed based on competencies. The system can use a combination of patient and clinical data, which enables providers to predict the probability of certain consequences, eventually providing more personalized care to patients. Integrating and automating pharmacy management operations will provide real-time visibility into inventory purchasing, like classifying medicine quantities across locations and forestalling upcoming shortages. All these factors can go a long way in reducing drug pricing.   

Conclusion:  

As the world continues its fight against COVID-19, healthcare organizations seek innovative ways to mitigate recent challenges. From telemedicine to remote access, healthcare software solutions offer answers to address value-based caregiving. Among other things, drug pricing needs to be designed to address the needs of the hour. As the healthcare panorama significantly shifts, medical solutions must be built to adapt to the requirements of remote caregiving, telehealth solution, and updated safety norms. Explore more interesting topics and listen to insightful podcasts related to healthcare only on CareTalk.