Healthcare Reform

May 15, 2012

The Affordable Care Act has less to do with healthcare reform than either supporters or opponents of the law might like to believe.

Yes, ACA probably is responsible for a 2% uptick in prescriptions filled by individuals between the ages of 19 and 25 in 2011. The 2010 law allows persons under the age of 26 to remain on their parents' health insurance.

But prescriptions filled by individuals over the age of 65 fell by 3.1% last year, according to the IMS Institute for Healthcare Informatics in Parsippany, N.J. The economy trumped ACA relief on Medicare Part D costs, which is no surprise.

"Even some ACA-specific provisions, like accountable care organizations [ACOs], will happen with or without the Supreme Court," said independent consultant Mary Jo Carden, RPh, JD, in Washington, D.C. "When it comes to value-based purchasing, quality metrics, and improved patient outcomes, the train has already left the station. Those models are moving independently of ACA."

"Medicaid is our largest payer," he said. "We have known for years that they need to find ways to deliver care more efficiently. What we came up with is a system based on increasing the quality of care and looking at the entire continuum of care, instead of silos called drugs and medical and labs and other services.

"It looks a lot like an ACO. But we created this system five years ago and have been working on it even longer. Obviously, we weren't thinking of ACA when we were looking for ways to improve the delivery of healthcare."