Darden Conference Wrestles With Big Changes Coming to Health Care

Though the long-term effects of health care reform are still murky, the health care landscape in the United States will change significantly, with ongoing consolidation of health insurers and hospitals, the influx of more patients into the system and a growing demand that people take responsibility for their own health.

A panel of four experts made those predictions Friday at the University of Virginia’s Darden School of Business as part of the 2012 Darden Health Care Conference, titled “What Does Health Care Reform Mean for ME?”

The featured speakers included Dr. Paul Matherne, J. Francis Dammann Professor of Pediatrics and vice chair for clinical strategy and program development at the U.Va. Health System; Steve Arner, senior vice president of the Carillion Clinic; Owen Hunt, associate general counsel for Anthem Blue Cross and Blue Shield; and Anna McKean, executive vice president of strategic initiatives at Health Diagnostic Laboratory Inc.

Panelists spoke about the effects of the Patient Protection and Affordable Care Act, which President Obama signed into law in March 2010. The law, which is bringing sweeping changes to the country’s health care system, will be phased in over a number of years. Health care coverage will be required for all citizens by 2014.

The law’s effects will be felt on many fronts.

“Expect a wave of consolidation of health plans,” Hunt said. “The economies of scale will force consolidation over time.” Hospitals will also consolidate or align to cut costs.

Hunt said the entry of the formerly uninsured into the health care system, coupled with an aging population, will be challenging, especially since the number of physicians won’t increase. “Where we’re going to fall short is at the primary care level,” he warned.

The law also will require employees to have insurance coverage either through employers or a state or federal insurance exchange – a kind of insurance marketplace, where individuals and small businesses can buy coverage. Those exchanges are scheduled to open in 2014.

That could change the face of the workforce. Arner predicted that “as those exchanges become more robust, you’ll no longer need an employer for insurance.” That could mean more and earlier retirements and allow more people to start their own businesses. “I think that’s exciting,” he said.

Matherne said academic medical centers will face new funding problems as traditional sources of revenue used to pay for the uninsured go away, though he said “the business of medicine is medicine, but it’s a business. We can improve outcomes and decrease costs.”

Matherne told Darden students at the conference, “I think the opportunity for entrepreneurship is phenomenal. You just need to find innovative ways to apply non-medical solutions to medical problems.” The medical field itself is sometimes blind to answers, he said.

Also looming is a growing belief that patients should take care of themselves.

“The demand on the patient is coming,” Matherne said. “It’s going to be a whole different ballgame.” 

That demand, for example, may mean that patients with lung problems will have to stop smoking and those with diabetes may need to lose weight to be treated.

“It’s going to be a huge problem,” he said. “You have to go back to the start and educate people. There may be separate rules for high-risk patients who brought it on themselves.”

Arner said “care coordinators” will be needed to talk to and educate high-risk patients. Though expensive, the coordinators will save money in the long run.

McKean echoed those concerns. “Who is responsible for your health?” she asked. “Increasingly the responsibility is being driven back to the patient.” 

Her business – with more than 7,000 physicians using its services – provides preventive-focused health care, which she said is the model for the future.

“We focus on cardiovascular disease and diabetes,” she said. “You beat it one patient at a time.”

McKean urged Darden students who will lead and start companies to “create a culture of health in your company.”

Arner agreed that preventative medicine is the future. “We have an amazing health care system for acute episodes, but we need to figure out how to have less of these acute episodes,” he said.

In the end, consumers don’t pay anywhere near the full cost of top medical treatment. “That’s the biggest misconception: that it doesn’t cost anything,” Matherne said. “But you don’t pay the real cost. Imagine if you were paying only 1 percent of a car’s cost. I’d be driving a Maserati. Red.”

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