Patients have ‘skin in the game’ with health care reform

By Chris Van Gorder, president and CEO, Scripps Health

Jan. 1 marks the beginning of a mandate under the Affordable Care Act (ACA) for most Americans to obtain health insurance coverage or pay a penalty. The new year also means that no one can be denied coverage because of a pre-existing condition, and more people will qualify for Medi-Cal.

Despite implementation issues and other problems with the ACA, its goals are laudable. It is intended to ensure health care coverage for the 48 million uninsured and to rein in the nation’s skyrocketing health care costs, which total more than $3 trillion a year.

Health care in this country is already changing and must keep evolving because it’s broken. While it is a crisis, it also presents an opportunity for everyone involved, including patients, to identify areas for improvement.

We have to break out of the old paradigm of doctors ordering tests and treatments for patients as an answer to every real or perceived ill. Instead, patients and doctors must partner together to create individualized care plans that make sense, avoid waste and produce the best outcomes.

The ACA places more emphasis on wellness and prevention of illness, with hospitals being reserved for the sickest of the sick.  Insurance plans now must cover preventive services such as mammograms and annual physical examinations, but the real responsibility lies with the individual.

While preventive care will be covered, for example, it will be up to the patient to schedule and complete screening exams and wellness check-ups, which can identify potentially serious illnesses such as cancer in their earliest and most treatable stages.  Also, individuals will be encouraged to take inventory of unhealthy lifestyle behaviors, such as a diet high in sugar, fat or junk food, or a lack of exercise. Such behaviors have been proven to contribute to heart disease, diabetes and other preventable illnesses.

At Scripps, we have had programs in place since 2006 to encourage our employees to adopt healthier lifestyles, including a smarter diet, regular exercise and a healthy work-life balance. Besides being in step with the spirit of health care reform, it’s the right thing to do for our employees.  And physicians can help their patients make the same types of changes.

In the near future, innovations will make it easier for patients to partner in their care.  The fast-emerging world of digital medicine will bring health care to patients’ homes and even their smartphones, helping them better manage chronic conditions and enhancing their regular doctor visits.

While the ACA and its initiatives may not be perfect, it is the law of the land and a step toward addressing the nation’s health care problems. The next steps – and real change – will happen as health care providers and patients work together so the right care is delivered at the right time, in the right place.