An eventful year ahead for the healthcare industry

For healthcare communicators, 2012 will be an eventful year.

For healthcare communicators, 2012 will be an eventful year. Never mind that the Affordable Care Act, the landmark health-reform law, was passed in 2010 and will not be fully operational until 2014. This year has real consequences for healthcare companies, providers, and consumers.

With the second anniversary of the law's passage, the Supreme Court will soon make a judgment on the constitutionality of its elements. Arguments will be presented to the court this week. The law remains controversial, with about half the country supporting it and half opposed. 

This will play out in the public square, as opponents of the law demonstrate outside the court, and supporters like Families USA use patient testimony about the law's benefits. The administration is beginning communications initiatives aimed at shoring up support for the law that many regard as President Barack Obama's signature domestic achievement.

It may be hard to beat the Supreme Court for drama, but there are other important developments for Affordable Care Act in the year ahead.

For starters, Accountable Care Organizations, a centerpiece of health reform, went live January 1. These health systems are pioneers in an attempt to control healthcare costs by paying for quality of care instead of quantity of procedures. The organizations will be given a flat fee to cover all care for a small group of Medicare patients. If this approach is successful, it will end fee-for-service medicine and will be adopted by all US hospitals.

Two other provisions of the Affordable Care Act will affect providers this year. “Value-based purchasing” will start to base hospitals' Medicare payments on performance metrics, including patient satisfaction scores. Another regulation will penalize hospitals when patients are readmitted due to preventable complications.

The state exchanges, designed to offer consumers an array of affordable insurance products, must be up and running by 2014. By the end of this year, states will need to show they have made enough progress to launch in 2014. If they have not, the federal government will step in and take over the exchange. 

Insurance companies are gearing up to be competitive on these exchanges, which will create a hugely expanded marketplace for healthcare. They stand to gain some 30 million customers once the exchanges are operational. Companies are also working with the Department of Health and Human Services to define “essential benefits” that will be covered in health plans on the exchanges.

Although providers and insurers will be mainly impacted by the law this year, pharmaceutical companies will see a positive effect from the expansion of the “donut-hole” prescription drug coverage. This provision of the law gives seniors more access to prescription drugs and has already saved millions in drug costs.

A boon for consumers in 2012 is an element of the law that requires insurance companies to provide preventative health services at no additional costs to patients. These services will include contraception for women, a provision of the law that has been the subject of recent controversy. Yet the public supports preventative care, and policymakers believe it will reduce long-term healthcare costs.

Swirling around all of this are the judicial and political headwinds that could derail the law. The Supreme Court will rule on elements of the Affordable Care Act, though the ruling on the individual mandate, the requirement that everyone must buy health insurance, is by far the most consequential. Proponents argue that without the mandate, insurers can't provide coverage for people with pre-existing conditions and other requirements of the law.  

The mandate could be struck down, but the overall law upheld – a decision that would throw a wrench into implementation and cause many insurance companies to go out of business. In addition, it is an election year, with leading Republican candidates vowing to repeal the Affordable Care Act or to kill major parts of it through Congressional action.

Amid these uncertainties, the industry is moving forward in implementing the biggest piece of social legislation since Medicare. There are many twists and turns in the marketplace and on the policy front. Any way you look at it, healthcare communicators have a busy year ahead in helping companies navigate this new terrain.

Nancy Hicks is SVP in Ketchum's Washington office, and she serves as associate director of the agency's North America healthcare practice. She is the co-author of Healthcare Industry Communications: New Media, New Methods, New Message, which was published in late 2011.

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