View of Obamacare from inside the storm
Some of that global warming could be the hot air expended on Obamacare this campaign season.
What's interesting is that when Jim Hinton, CEO of Presbyterian Healthcare Services, speaks in public, he never sounds too worried. Neither do his peers at Lovelace Health System. And yet these two organizations will shoulder the lion's share of Affordable Care Act reforms for New Mexico.
Presbyterian and Lovelace have both supported expansion of coverage for the uninsured. Presbyterian even backed former Gov. Bill Richardson's effort to create state-funded universal care.
As for ACA, says Todd Sandman, a vice president at Presbyterian, "We think there's a lot of good innovation in the law. It rewards quality. It doesn't mean every line is how we'd write it."
Says Stephen Forney, Lovelace's vice president and chief financial officer, "We always take a very long view of the system and the market in New Mexico so we're prepared. We've had our eyes on health care reform for a long time."
That said, there's anxiety out there about how ACA will translate at all levels. Forney wants to see "the rules written so we all know what we're supposed to do."
Both organizations have been moving in that direction for years – retooling, reorganizing, training and retraining, and keeping their eye on the bouncing ball. Quality and affordability dominate their internal and external discussions.
"Our hospitals have been looking down the road to understand what new demands would be," says Forney. "Perhaps there will be a shift from emergency room utilization to less acute environments like Urgent Care, because people will have insurance and won't wait to see a doctor."
Lovelace has expanded OB-gyn and pediatrics programs. Its Roswell hospital, which is already short of primary care, is working to expand. "We consistently have been looking at services we can provide on an outpatient basis to serve a new population," Forney says.
About now, you might be thinking, of course they support ACA – they're big enough to survive the changes, and the law creates more customers for them. Actually, the law is a two-edged sword. Presbyterian and Lovelace have health plans, hospitals and other facilities, so they have to absorb thousands of new patients as they maintain a desired quality of care and keep costs competitive.
It's quite a balancing act, which is why Sandman also talks about risk taking.
Some of their comfort level is a front-row seat in the theater of change. If you got a flu shot at your local pharmacy, you've seen the tip of the iceberg. "Going to the doctor" might mean seeing a physician's assistant, a nurse, a nurse practitioner, a medical student, or some other health professional. Telemedicine can bring specialists to small, rural hospitals. Care will match the need.
Coming soon to your community will be the medical equivalent of the county extension agent, called a health extension coordinator, says Arthur Kaufman, vice chancellor for community health at UNM Health Sciences Center. New Mexico, the first to have this program, has 10 of these extension agents so far, soon expanding to 15. The agent will work with the community to set priorities and then become the link between the community and UNM, which already has clinics and training programs around the state.
Another fast-growing component is the community health worker. More than half the obstacles in health care delivery are what Kaufman calls social determinants – lack of transportation, poor nutrition, confusion about how the health-care system works, misunderstandings about medications. The community health worker will tackle these issues.
These new hands will also ease our doctor shortage.
Nobody says it will be easy, but these three people in the eye of the storm do agree on the need for change. Our next priority is to make sure ACA and other laws keep up.