Healthcare organizations that were previously sitting along the sidelines when it came to healthcare reform are going to have to get the ball rolling now that the Supreme Court has made the ruling to uphold the 2010 healthcare law, according to a report published Friday by the PwC Health Research Institute (HRI).
"As the law moves forward, it's game on for those organizations that were sitting on the fence," said Benjamin Isgur, director of the HRI. "It's now time for them to move forward. I think the first thing crossing everyone's minds is that there's almost a sigh of relief due to the certainty now. Before, there was a lot of uncertainty, and it took a lot of organizational energy. At the end of the day, most of the industry leaders have to serve patients and install technology no matter what. There are a lot of things to get done on a daily basis, and the political noise would often get in the way."
In the report about Implications of the U.S. Supreme Court ruling on healthcare, HRI discusses its beliefs on what will come next for states, employers, insurance companies, physicians, hospitals and other providers and pharmaceutical and life sciences companies.
"Incentives for collaboration are quickening the convergence of hospitals, insurers, drugmakers, physicians and technology companies. Creation of new state and private insurance exchanges, greater pricing transparency, mobile technology and nontraditional competitors are turning the health business into a retail operation," according to the report.
In addition, the court's decision clears the path for a "new era of healthcare megapayers - the federal government, large employers and state insurance exchanges empowered to direct business based on health outcomes," said the report.
Also, implementation deadlines are now approaching quickly so there is renewed pressure on health organizations not only to comply with rules and compliance deadlines but also to find more innovative ways of delivering high-quality, affordable care, said Isgur.
Among the provisions in the healthcare law that are scheduled to take effect soon are new reporting and disclosure obligations for employers, benefit design changes for certain health plans, penalties for hospitals that have unnecessarily high readmissions and a requirement that insurers devote 80-85 percent of their premiums to medical care or refund the difference. In addition, participants will need to accelerate efforts to be competitive for federal funding that will be available for innovation, health insurance exchanges, new quality measures and other provisions of the law.
To date, more than $1 billion in grants has been allocated to support state exchange readiness, and Medicaid spending is expected to total $4.2 trillion from 2012 to 2021. With 23 million individuals anticipated to buy insurance from the exchanges and 17 million people enrolling in Medicaid by 2021, the two provisions are heightening activity in states.
HRI analysis shows that so far, 29 percent of states (14 states plus Washington, D.C.) have made significant progress toward reform, while 37 percent (19 states) have made moderate progress. The remaining 33 percent (17 states) have done less to implement the law.
"It's becoming quite clear to everyone that we are living in a world of constant change and fluctuation when it comes to healthcare," said Isgur.