The spotlight was on the court's decision to uphold the so-called “individual mandate” given teeth by the tax that the law will impose, starting in 2014, on individuals who lack health insurance.
But the Affordable Care Act was always about much more than expanding coverage. The law also aims to make health care more affordable while improving its quality. To that end, the law is a cauldron of experimentation – and opportunity for PR.
To be sure, changes in the health care landscape were inevitable no matter what the court did, because the US health care system isn't all it's cracked up to be. We spend 50 percent more on health care per capita than any other country in the world. Despite this, Greece, Hungary, and Korea all have lower infant mortality rates than the United States, and people in Ireland, Slovenia, and Luxembourg all live longer than we do.
What has happened is the people who pay for health care have told the people who provide it that they and their employees, or constituents, cannot continue to bear the brunt of the world's most expensive health care. The cost for insured families has doubled in the last decade.
Employers are now dropping coverage or passing along significantly greater costs to their employees. Medicare and Medicaid costs are breaking governments. They are asking to pay for care in new ways that are driving changes in how it is delivered.
Here are some of the more significant implications for PR:
First, these efforts will continue to drive the massive restructuring that is underway as health systems and insurers figure out a new world order that is blurring the lines between companies that manage risk – insurers – and those that provide care – health systems. When one-sixth of the US economy restructures, opportunities arising out of merger and acquisition activities abound for corporate practices.
Second, these new players will be increasingly reimbursed based on the value of the care they provide, not the volume. There will also be greater transparency about the quality of care they provide to counterbalance concerns that “managing care” is paramount to rationing or denying care. In other words, PR will be called on to make sure “care management” isn't seen as “managed care,” the graveyard where HMOs were buried.
PR will need to develop a new language that communicates the benefits of these new-fangled care delivery vehicles with clunkers like “accountable care organizations” and “patient-centered medical homes” for names. You can see our approach here.
Third, instead of merely rescuing people when they are ill, these new players will work harder to keep them well. Think health, not health care. This will place a premium on understanding how to drive healthy behaviors: wellness, accessing preventive care, taking medications as prescribed, and so on.
Fourth, stakeholder communications are more important than ever. Health systems not only have to concern themselves with not scaring patients about the changes, they have to work closely with doctors and other providers to close down silos and coordinate care across the continuum.
They need to persuade doctors on why they might be better off working for a health system than hanging out a shingle, a task that is becoming increasingly easier in many areas of the country. And they cannot operate separately and apart from the people who pay the bills. Employers are more willing than ever to close their network of health care providers in return for saving money. Health systems will need to make the case, explaining why they should be that network.
It was increasingly obvious in the days leading up to the court's decision that change was here to stay, no matter what the court did. Media accounts quoted executives from major insurance companies to modest-sized health systems as saying there would be no turning back. And where there is change, PR isn't far behind.
Chuck Alston is SVP at MSL Washington DC and director of public affairs for MSLGROUP Americas, part of the flagship specialty communications and engagement network of the Publicis Groupe.