Unintended Consequences of Healthcare & Life Sciences Legislation 2014
Unintended Consequences of Healthcare & Life Sciences Legislation 2014
March 2014 | Research Report
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Key Insight
“In addition to any positive or negative unintended consequences of current or future legislation, the U.S. healthcare system will be faced with a series of dramatic changes, unlike anything we’ve seen before..”
Introduction
Welcome to this executive summary and research report on the Center for Healthcare Innovation’s 2nd annual Unintended Consequences of Healthcare & Life Sciences Legislation Symposium, which took place in Washington, DC on October 15, 2014. This non-partisan symposium featured some of the world’s leading healthcare, life science, and government experts coming together in a collaborative setting to discuss the most pressing legislative issues facing the healthcare and life sciences industries in the 21st century. Unintended consequences are the unanticipated and unforeseen outcomes of government action that are not the outcomes intended by the executive and legislative branches. There are three basic categories: (i) a positive, unexpected benefit, (ii) a negative, unexpected detriment, and (iii) a perverse effect substantially contrary to the original purpose of the law or regulation. Examples in healthcare and life sciences include the Orphan Drug Act of 1983 and the emergence of mini-med healthcare plans (total coverage capped at very low amounts). There are likely to be a wide array of unintended consequences resulting from the Affordable Care Act and other legislation in the U.S. and around the world.
In addition to any positive or negative unintended consequences of current or future legislation, the U.S. healthcare system will be faced with a series of dramatic changes, unlike anything we’ve seen before. Patients are more informed, engaged, and financially invested in their healthcare than ever before. And as a result, provider and biopharma organizations are following patients’ lead and recalibrating themselves as patient-centric, consumer-driven organizations. Moreover, healthcare costs are rising at unsustainable rates. As these major trends drive healthcare change, there will be a new emphasis on maximizing healthcare value, with a particular emphasis on improving quality, increasing access, and reducing costs.
This executive summary captures and examines some of the insights, ideas, best practices, and new perspectives from the Symposium and the broader healthcare legislation discussion. It is meant to serve as a summary and a resource of the innovative ideas and insights regarding legislation for healthcare and the life sciences. We hope that you find it to be both thought-provoking and useful, and we welcome your feedback. We thank you for your interest and hope this can be an asset for you and your organization.
Chapter 1
The Center for Healthcare Innovation’s 2nd Annual Unintended Consequences of Healthcare and Life Sciences Legislation Symposium began with an informative and Distinguished Welcoming Address by Elizabeth Flury, Chief Strategy Officer of the Children’s National Health System. Ms. Flury has witnessed firsthand the myriad of changes, both intended and unintended, that have occurred in the healthcare industry over the past decade.
These changes are affecting every stakeholder in the healthcare ecosystem, including patients, providers, payers, pharma, and policymakers. The unintended consequences of healthcare legislation will have seismic shifts in relevancy for many established players in the healthcare industry. Additionally, these unintended consequences will allow new players to emerge, as well as result in many existing players recalibrating as a result of our new healthcare reality.
Organizations need to constantly evaluate their role in a constantly and rapidly shifting healthcare landscape, as traditional ways of doing business are becoming obsolete and antiquated. And more often than not, this can happen before organizations can adapt to the extremely rapid change of pace in healthcare, especially if an organization does not have clearly defined goals. Many organizations now overtly state that they are constantly trying to improve the “quality” of healthcare. However, there has been no concrete definition of what “quality” actually is, and its definition varies among and even between physicians, payers, providers, and patients. This ambiguity will lead to many challenges and opportunities for organizations in the coming years, and it remains to be seen who will be able to adapt quickly enough to the new healthcare landscape.
One of the main unintended consequences of the Affordable Care Act is the large number of disruptive organizations that are now entering the healthcare ecosystem. For instance, Wal-Mart has recently joined the fray, with the opening of Wal-Mart clinics that offer cheap, convenient healthcare at consumers’ local store. The Wal-Mart model of providing quality goods at lower prices and fast- er speeds than competitors is now being applied to healthcare. The established healthcare providers need to adapt to this new reality of care that providers like Wal-Mart can now provide, with an emphasis on fast, personalized care and cheap treatments. Other new players that are emerging in the aftermath of the Affordable Care Act also include public-private partnerships. Philanthropists and non- profits are now pairing with for-profit organizations to provide resources and treatments to orphan populations who previously would not have received much attention. This improved care for some of the more vulnerable members of society will contribute to better overall societal health.
Finally, other industries and organizations are having difficulty adjusting to the new healthcare landscape. Some of these groups that are facing the most upheaval are research institutes and academia. In the past, most major research centers focused solely on performing research and did not have to worry about being self-sustaining organizations. However, many of those organizations are now being required
to adapt to become self-sustaining organizations. Additionally, many of the leaders in academia are now being forced to interact, collaborate, and partner with other organizations. However, these new opportunities for collaboration and partnership should be able to help many organizations adapt to the recent changes in healthcare, both intended and unintended.
Key Points:
Changes in healthcare are going to affect existing stakeholders, as well as create new opportunities for new players in the healthcare industry.
Organizations need to clearly understand their role and how they define healthcare quality in order to adapt to a rapidly-changing healthcare landscape.
A primary unintended consequence of the ACA is the emergence of new players and models that are now entering the healthcare ecosystem, which may force the traditional stakeholders to reevaluate and update their models.
Research institutes and academia are facing upheaval as they adjust to the new healthcare landscape. However, new opportunities for collaboration and partnership should be able to help organizations adapt to the recent changes in healthcare, both intended and unintended.
To view the full report, please click on the "download" button to receive a full PDF copy.
Joseph Gaspero is the CEO and Co-Founder of CHI. He is a healthcare executive, strategist, and researcher. He co-founded CHI in 2009 to be an independent, objective, and interdisciplinary research and education institute for healthcare. Joseph leads CHI’s research and education initiatives focusing on including patient-driven healthcare, patient engagement, clinical trials, drug pricing, and other pressing healthcare issues. He sets and executes CHI’s strategy, devises marketing tactics, leads fundraising efforts, and manages CHI’s Management team. Joseph is passionate and committed to making healthcare and our world a better place. His leadership stems from a wide array of experiences, including founding and operating several non-profit and for-profit organizations, serving in the U.S. Air Force in support of 2 foreign wars, and deriving expertise from time spent in industries such as healthcare, financial services, and marketing. Joseph’s skills include strategy, management, entrepreneurship, healthcare, clinical trials, diversity & inclusion, life sciences, research, marketing, and finance. He has lived in six countries, traveled to over 30 more, and speaks 3 languages, all which help him view business strategy through the prism of a global, interconnected 21st century. Joseph has a B.S. in Finance from the University of Illinois at Chicago. When he’s not immersed in his work at CHI, he spends his time snowboarding backcountry, skydiving, mountain biking, volunteering, engaging in MMA, and rock climbing.