2017 brings another year of uncertainty, change in health care

Angela Mattie Quinnipiac University professor, trustee of St. Mary's Hospital, Yale New Haven Health community council member, and board member of Qualidigm

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Q&A talks with Angela Mattie, a Quinnipiac University professor, trustee of St. Mary's Hospital, Yale New Haven Health community council member, and board member of Qualidigm.

Q: What might Donald Trump and a Republican-controlled Congress mean for Connecticut's healthcare market?

A: We know the Affordable Care Act is not the be-all, end-all, and it's fraught with difficulties. Were some of those expected for a program of this magnitude? Yes, but that doesn't mean we have to throw out the baby with the bathwater.

We have the lowest uninsured rate in this country than we've had in years. Twenty-million people gained insurance benefits since the law was enacted in 2010. What we don't understand as a society is that we end up paying for uninsured individuals.

What's going to happen with Obamacare is largely unknown right now. President-elect Trump indicated he is in favor of maintaining the ability for individuals to get insurance for pre-existing conditions and for those still dependent on their families to get coverage until age 26.

Here's the problem with that: One basic premise of insurance coverage is you need to be able to spread the risk. You can't do that without individual mandates and subsidies. So if you were to maintain the coverage for high-cost individuals with pre-existing conditions, but eliminate the mandate, we would have extremely expensive premiums. It would be an untenable scenario.

Q: Connecticut has certainly been no exception in the ongoing trend of healthcare consolidation. What might 2017 bring?

A: I personally would no longer call it a trend, but a reality in the industry. Connecticut was slower than the rest of the country to begin consolidation, but now we have three major healthcare hubs in the state: Yale New Haven Health, Trinity Health-New England and Hartford HealthCare. We still have a few excellent community hospitals that are holding on, but I think in general, the small community hospitals are going the way of the dinosaur.

Large healthcare systems allow for economies of scale, decreased administrative costs and deep clinical expertise in specific areas. If we move to a value-based healthcare system, which I hope we will, there will be more ability to implement systems and processes through large healthcare systems.

Q: There's been some progress on population-based care, but many insurer-provider contracts remain rooted in a fee-for-service model. What can be done?

A: Currently our healthcare system depends mostly on fee-for-service reimbursement. Healthcare providers get paid for sick patient care. This creates a perverse incentive system. We need to incentivize well care.

We are currently experiencing a sea change, which has caused a lot of healthcare organizations to live in an era of ambiguity. We don't know, given the election, if we're going to continue to move toward the development of accountable care organizations or what contract structures are going to look like. This is a very difficult time for providers as they straddle both sides of the fence. The reimbursement structure is lagging behind the development of value-based programs.

Q: How are healthcare providers doing with electronic medical records?

A: We have made great strides in moving from a paper-based, medical-record system to a computer-based system. The same is not true of hospitals sharing information outside of a system affiliation. This has a significant impact on patient care.

For instance, if you were to go to Florida and have a car accident, the emergency department doctor wouldn't have access to what medications you were on, what other medical conditions you have or any of your existing medical records. It's appalling that we have more sophisticated systems for Macy's charges than we have for our healthcare records.

Part of the problem has to do with technology, but the lack of interoperability is mostly a competitive issue. It's one way of maintaining patients in your healthcare system. Short of a legislative fix at the federal level, we might not see this change and therefore we will continue to hinder the quality of care.

Q: What else do you feel is important to watch in health care next year?

A: Patient safety. A May 2016 article in a British medical journal reported that medical errors are the third leading cause of death in the U.S. This is unacceptable and it's not because providers show up wanting to do a bad job.

We need to support our providers with a culture of safety that encourages system improvements and the ability to discuss errors and potential fixes without fear of retribution. Our healthcare system needs better care coordination, improved IT systems, enhanced communication and teamwork among providers and a focus on interdisciplinary education of the next generation of healthcare providers.

Second, retail giants like CVS and Wal-Mart are becoming big players in the healthcare system.

We're moving into an era of care-model disruptors and innovators. These new participants cater to the patient in terms of hours and types of services offered. Since health care is a huge part of our economy, and it's been a very lucrative part of our economy, you'll see more non-traditional delivery models entering the field.