By Kevin O'Neil
 The Affordable Care Act enacted in 2010 has ushered in a major transformation in the American health care system. Not only is the ACA focused on expanding access to affordable and quality care, but also on reducing the overall costs of health care. Health care spending has been on an unsustainable path. Medicare spending had been doubling every 10 years, but recent figures suggest a slowing in cost growth. Still, more than a third of health care spending has been deemed unnecessary. Moving from a fragmented fee-for-service system that rewards volume to one based on value has not been easy, but is certainly necessary.
kAm$F49 2 DJDE6> H:== C6BF:C6 36EE6C 42C6 4@@C5:?2E:@? 24C@DD E96 6?E:C6 962=E9 42C6 56=:G6CJ DJDE6>] }@H96C6 :D 42C67F= 42C6 4@@C5:?2E:@? >@C6 :>A@CE2?E E92? :? E96 @=56C 25F=E A@AF=2E:@?] ~=56C A6CD@?D >2J 92G6 >F=E:A=6 4@>A=6I >65:42= 4@?5:E:@?D 2D H6== 2D A9JD:42= 2?5 4@8?:E:G6 492==6?86D] %C2?D:E:@?D 7C@> @?6 D6EE:?8 @7 42C6[ DF49 2D 2? 24FE6 42C6 9@DA:E2=[ E@ 2?@E96C D6EE:?8 DF49 2D 2 9@>6[ 2 ?FCD:?8 9@>6[ @C 2? 2DD:DE65 =:G:?8 724:=:EJ :D 2? 6DA64:2==J GF=?6C23=6 E:>6 7@C 2? @=56C 25F=E]k^Am
kAmxE :D F?FDF2= E96D6 52JD 7@C 2? :?5:G:5F2=VD AC:>2CJ 42C6 AC24E:E:@?6C E@ @G6CD66 42C6 :? E96 9@DA:E2=] %9:D :D FDF2==J 5@?6 3J 9@DA:E2=:DED] x? D<:==65 ?FCD:?8 724:=:E:6D[ 42C6 :D @7E6? AC@G:565 3J Q$}u:DED]Q ~E96C AC@G:56CD 92G6 =:>:E65 E96:C D6CG:46D E@ A6@A=6 C6D:5:?8 :? 2DD:DE65 =:G:?8 724:=:E:6D H9:=6 A2==:2E:G6 2?5 9@DA:46 42C6 :D FDF2==J AC@G:565 3J DA64:2=:DE A9JD:4:2?D 2?5 ?FCD6D 56G@E65 E@ A6CD@?D H:E9 D6G6C6 49C@?:4 >65:42= 4@?5:E:@?D 2?5 6?5\@7\=:76 42C6]k^Am
kAm%9:D 7C28>6?E2E:@? @7 E96 962=E9 42C6 DJDE6> 4C62E6D >2?J @AA@CEF?:E:6D 7@C >:D4@>>F?:42E:@?] $F49 4@>>F?:42E:@? 82AD 42? C6DF=E :? 25G6CD6 >65:42E:@? 6G6?ED[ F??646DD2CJ 6>6C86?4J C@@> G:D:ED 2?5 2G@:523=6 9@DA:E2= C625>:DD:@?D] !C:@C E@ E96 6?24E>6?E @7 E96 prp[ 2? 6DE:>2E65 a_ A6C46?E @7 2== |65:42C6 36?67:4:2C:6D 5:D492C865 7C@> E96 9@DA:E2= H6C6 C625>:EE65 H:E9:? b_ 52JD] %96 r6?E6C 7@C |65:42C6 2?5 |65:42:5 $6CG:46D 6DE:>2E65 E92E `b A6C46?E @7 E96D6 C625>:DD:@?D H6C6 2G@:523=6 \\ 2?5 4@DE E96 DJDE6> >@C6 E92? S`a 3:==:@?] |@C6 C646?E C6D62C49 DF886DED E92E 2? 6G6? 9:896C A6C46?E286 @7 F?A=2??65 9@DA:E2=:K2E:@?D 2?5 C625>:DD:@?D 2C6 2G@:523=6]k^Am
kAm%96 EC6>6?5@FD 8C@HE9 :? E96 ?F>36C @7 244@F?E23=6 42C6 @C82?:K2E:@?D 2?5 |65:42C6 p5G2?E286 !=2? 6?C@==66D :D E6DE:>@?J E@ E96 8@G6C?>6?EVD :?E6?E:@? E@ 4@?EC@= 4@DED 2D H6== 2D E@ :>AC@G6 BF2=:EJ] u@C @C82?:K2E:@?D E@ 244@>A=:D9 E96 %C:A=6 p:> @7 r|$ \\ :>AC@G65 BF2=:EJ @7 42C6[ C65F465 4@DED 2?5 :>AC@G65 42C6 6IA6C:6?46 \\ >6E:4F=@FD 42C6 4@@C5:?2E:@? :D 6DD6?E:2= E@ C65F4:?8 F??646DD2CJ 9@DA:E2=:K2E:@?D[ H9:49 :D E96 >@DE 6IA6?D:G6 42C6] %9FD[ E96C6 :D 2 AFD9 E@ 5C:G6 42C6 E@ =6DD 6IA6?D:G6 6?G:C@?>6?ED H96? 2AAC@AC:2E6[ 762D:3=6 2?5 D276]k^Am
kAmw@>6 42C6 2?5 2DD:DE65 =:G:?8 H:== 364@>6 >@C6 2?5 >@C6 :>A@CE2?E :? E96 6G@=G:?8 962=E9 42C6 >2C<6EA=246] #6D62C49 92D D9@H? E92E D6G6C2= >65:42= 4@?5:E:@?D DF49 2D D@7E E:DDF6 :?764E:@?D 2?5 566A G6:? E9C@>3@D:D W3=@@5 4=@EDX 42? 36 >2?2865 2E 9@>6 H:E9 36EE6C @FE4@>6D 2?5 2E =@H6C 4@DE E92? :? 2 9@DA:E2=] |@C6 H:56DAC625 :>A=6>6?E2E:@? @7 DF49 AC@8C2>D 92D 366? 92>A6C65 3J E96 724E E92E |65:42C6 2?5 4@>>6C4:2= A2J@CD 92G6 366? C6=F4E2?E E@ C6:>3FCD6 AC@G:56CD 7@C 56=:G6C:?8 42C6 :? E96D6 D6EE:?8D] %92E H:== =:<6=J 492?86]k^Am
kAmpDD:DE65 =:G:?8 C6AC6D6?ED 2? F?E2AA65 @AA@CEF?:EJ :? E96 >:DD:@? E@ >66E E96 %C:A=6 p:>] r|$ :D 2=C625J :>A=6>6?E:?8 3F?5=65 A2J>6?ED 7@C 42C6 6A:D@56D E92E :?4=F56 9@DA:E2= 42C6[ A9JD:4:2? D6CG:46D 2?5 A@DE\24FE6 42C6] pDD:DE65 =:G:?8 :D 2 >F49 =6DD 6IA6?D:G6 @AE:@? E92? D<:==65 ?FCD:?8[ 2?5 E96 677:4:6?4:6D @7 D42=6 42? >2<6 2 C6DA:E6 DE2J :? 2DD:DE65 =:G:?8 2 =6DD 6IA6?D:G6 @AE:@? E92? 9@>6 42C6] |@C6 2?5 >@C6 2DD:DE65 =:G:?8 @C82?:K2E:@?D 2C6 >@G:?8 E@H2C5 2? :?E68C2E65 42C6 >@56= H:E9 E96 2G2:=23:=:EJ @7 @?D:E6 9@>6 962=E9 2?5 E96C2AJ D6CG:46D] pDD:DE65 =:G:?8 2=D@ AC@G:56D 2? @AA@CEF?:EJ 7@C D@4:2=:K2E:@?[ H9:49 :D 6IEC6>6=J :>A@CE2?E 7@C @G6C2== H6==\36:?8]k^Am
kAmt7764E:G6 4@>>F?:42E:@? 36EH66? E96D6 D6CG:46 =:?6D :D <6J] |:D4@>>F?:42E:@? @7 :>A@CE2?E :?7@C>2E:@? :D 2 4@>>@? 42FD6 7@C C625>:DD:@?D] v6@C86 q6C?2C5 $92H @?46 D2:5[ Q%96 D:?8=6 3:886DE AC@3=6> :? 4@>>F?:42E:@? :D E96 :==FD:@? E92E :E 92D E2<6? A=246]Qk^Am
kAmx7 :>A@CE2?E :?7@C>2E:@? 23@FE 2 A6CD@?VD >65:42= 4@?5:E:@?D @C >65:42E:@? C68:>6? :D ?@E 4@>>F?:42E65 AC@A6C=J H96? 2 A6CD@? EC2?D76CD 7C@> @?6 42C6 D6EE:?8 E@ 2?@E96C[ DF49 2D E96 9@DA:E2= E@ 9@>6 @C E@ 2 D<:==65 ?FCD:?8 724:=:EJ[ 25G6CD6 6G6?ED E92E EC:886C 2 C625>:DD:@? 42? @44FC]k^Am
kAm%92?<7F==J[ :??@G2E:G6 AC@;64ED 92G6 366? DFAA@CE65 3J r|$ E@ :>AC@G6 42C6 EC2?D:E:@?D 2?5 C65F46 E96 C:D< 7@C 25G6CD6 @FE4@>6D] x? a_`a[ r|$ AC@G:565 7F?5:?8 E@ `_f @C82?:K2E:@?D ?2E:@?H:56 E92E 925 56>@?DEC2E65 @C AC@A@D65 :??@G2E:G6 42C6 >@56=D E@ 249:6G6 E96 %C:A=6 p:>] qC@@<52=6 $6?:@C {:G:?8[ :? 4@==23@C2E:@? H:E9 E96 &?:G6CD:EJ @7 }@CE9 %6I2D w62=E9 $4:6?46D r6?E6C[ H2D 2 C64:A:6?E @7 @?6 @7 E96 r|$ w62=E9 x??@G2E:@?D r92==6?86 vC2?ED] qC@@<52=6 925 AC6G:@FD=J 4C62E65 2 42C6 EC2?D:E:@?D AC@8C2> E92E D:8?:7:42?E=J C65F465 2G@:523=6 C625>:DD:@?D 7C@> :ED D<:==65 ?FCD:?8 724:=:E:6D :? r=6G6=2?5] W$F3D6BF6?E C6A=:42E:@? @7 E9:D AC@8C2> :? z2?D2D r:EJ 2?5 {6I:?8E@? DF886DE65 E92E E9:D AC@8C2> 4@F=5 36 5:DD6>:?2E65 E@ 2== @7 qC@@<52=6VD D<:==65 ?FCD:?8 724:=:E:6D]Xk^Am
kAmp? :>A@CE2?E 4@>A@?6?E @7 E9:D AC@8C2> H2D 2 BF2=:EJ :>AC@G6>6?E AC@;64E 42==65 x}%t#pr% \\ x?E6CG6?E:@?D E@ #65F46 p4FE6 r2C6 %C2?D76CD \\ H9:49 H2D 4C62E65 3J sC] y@D6A9 ~FD=2?56C 2?5 4@==628F6D 2E u=@C:52 pE=2?E:4 &?:G6CD:EJ] x}%t#pr% 4@?D:DED @7 2 G2C:6EJ @7 QE@@=DQ E92E :?4=F56 4964<=:DED[ AC@E@4@=D 2?5 2=8@C:E9>D 7@C :56?E:7J:?8 2?5 >2?28:?8 492?86D :? 2 A6CD@?VD 962=E9 4@?5:E:@? 2?5 AC6G6?E:?8 :>A@CE2?E :?7@C>2E:@? 7C@> 72==:?8 E9C@F89 E96 4C24<D]k^Am
kAmp?@E96C :>A@CE2?E 2DA64E @7 E96 r|$ w62=E9 x??@G2E:@?D r92==6?86 vC2?E H2D E96 >@5:7:42E:@? @7 E96 x}%t#pr% E@@=D 7@C 2AA=:42E:@? :? E96 2DD:DE65 =:G:?8 A@AF=2E:@?] |2?J C6D:56?ED @7 2DD:DE65 =:G:?8 92G6 >65:42= 4@?5:E:@?D E92E A=246 E96> 2E 9:89 E@ >@56C2E6 C:D< 7@C 9@DA:E2=:K2E:@?D 2?5 C625>:DD:@?D] %96 x}%t#pr% AC@8C2> >@5:7:65 7@C 2DD:DE65 =:G:?8 H2D D:8?:7:42?E=J 2DD@4:2E65 H:E9 2 C65F4E:@? :? 9@DA:E2=:K2E:@?D 7@C 24FE6 42C6 2?5 2 C65F4E:@? :? E@E2= |65:42C6 4@DE] $:?46 :>AC@G:?8 A@AF=2E:@? 962=E9 2?5 C65F4:?8 2G@:523=6 9@DA:E2=:K2E:@?D 2?5 C625>:DD:@?D 2C6 E@A AC:@C:E:6D @7 r|$[ :E H2D 4@?4=F565 E92E E96 >@5:7:65 x}%t#pr% AC@8C2> 42? 36 DF446DD7F==J 2AA=:65 E@ C6D:56?ED :? E96 2DD:DE65 =:G:?8 D6EE:?8]k^Am
kAm%96D6 2C6 492==6?8:?8 E:>6D :? 962=E9 42C6[ 3FE 492==6?86D 4C62E6 @AA@CEF?:E:6D] (6 2D 2 ?2E:@? 2C6 :? 2 F?:BF6 A@D:E:@? ?@H E@ 96=A 3C:586 E96 BF2=:EJ 492D>] %96 DE2EFD BF@ :D ?@E 2446AE23=6] (6 42? 6=:>:?2E6 6CC@CD E92E @44FC 52:=J :? E96 42C6 @7 @=56C 25F=ED 2?5 6?92?46 E96 H6==?6DD 2?5 962=E9 @7 E9@D6 H9@ 6?ECFDE E96>D6=G6D E@ @FC 42C6] qFE E9:D H:== C6BF:C6 DJDE6>D :??@G2E:@?D E92E H:== :>AC@G6 E96 =:G6D @7 >2?J >:==:@?D @7 @=56C p>6C:42?D]k^Am
kAmk6>mz6G:? ~V}6:= :D E96 49:67 >65:42= @77:46C 2E qC@@<52=6 $6?:@C {:G:?8]k^6>mk^Am
