Learn your lessons well

Affordable, quality care is the primary goal of President Barack Obama's healthcare reform.

“The purpose of this act was to improve the quality of healthcare services, augment comprehensive delivery systems, cost containment, and focus on planning for health needs.”
-- Purpose of the Health Planning Act of 1974, Dr. D.T. Cappucci, Jr.

Affordable, quality care is the primary goal of President Barack Obama's healthcare reform. But the goals of the Affordable Care Act also were the reasons behind passage and implementation of the Health Planning Act, signed into law in 1974.

Most readers won't remember the Health Planning Act, but I do. Working with hospital CEOs in the mid-1970s, I spent countless hours endeavoring to comply with the act, preparing presentations for the local “Health System Agency” that had the power to grant or deny our application (certificate of need) to expand, to add specific therapies, or to purchase equipment. The government was concerned about duplication of services and about hospitals' understandable desire to pursue the most profitable areas of care as a means of supporting those on which they were losing money.

The reason you don't remember the Health Planning Act is because it failed. It was repealed in 1986. Instead of creating community consensus for how best to serve patients, the act created resentment among all stakeholders. Hospitals saw it as an obstacle to addressing real community needs; physicians felt it hindered access to the best available treatments; patients resented having to make long trips for care that might have been accessible at a hospital closer to home.

But the real failure was one of communication. Few, if any, resources were committed to aligning stakeholder interests, to explaining the purpose of the Act and the need for a bureaucracy to support it, and to teaching patients, physicians, and others how to access and influence the Health Systems Agency. Decisions seemed arbitrary, frustration was rampant, and litigation quickly followed. The act was repealed.

Today, as we begin a radical makeover of the healthcare delivery system amidst great uncertainty, we hear little about the Affordable Care Act, except from politicians campaigning to repeal it. While there is much conversation inside the Beltway and in some state capitals about health insurance exchanges, accountable care organizations, and the shape of the essential health benefits package, those who are delivering care and those who are consuming it remain largely in the dark.

In his recent State of the Union Address, Obama devoted only 44 of more than 6,800 words to healthcare. He and his administration are neither explaining nor defending this latest attempt to control costs and ensure access to care. Changes that will impact patient care already are underway. Communicating those changes also should be well underway, ensuring all who touch the healthcare system understand what's coming and why. This is a primary task of government.

Officials in charge of implementing the Affordable Care Act must realize the strategic importance of preventing this latest effort from following in the path of the now-forgotten Health Planning Act. Those who cannot learn from history…

Robert L. Chandler is principal of Chandler Chicco Companies and SVP of marketing and communications and head of inVentiv Health Communications/Europe.

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