How Does The ACA (“Obamacare”) Effect Workers’ Compensation? – an Interview with SEAK Speaker Harris Allen, Jr., PhD
Interviewer: I’m here today at the SEAK National Worker’s Compensation and Occupation and Medicine Conference with Dr. Harris Allen of Harris Allen Group, and independent consulting firm. Dr. Allen, how can we expect the Affordable Healthcare Act, the ACA to impact Worker’s Comp and Occupational Medicine professionals?
Dr. Harris Allen: Well the short answer is indirectly, but substantially. The Affordable Care Act has specific provisions in it that focus on healthcare in general, and for employee populations, for those that are insured by a commercial plans. It does not have any specific provisions in it dealing directly with Worker’s Comp, or for those services delivered by occupational health professionals that for causes that are deemed work related. All this said, what’s happening on the healthcare side is quite substantial; major stakeholder provisions affecting how employers, health plans, and providers all go about doing their business. And those changes will affect how Worker’s Comp and Occupational Health professionals go about doing their work.
Interviewer: And how is this system likely to change over the next few years?
Dr. Harris Allen: We are likely to see greater rates of the uninsured becoming insured. We are likely to see the provisions dealing with employers specifically to continue to ratchet up, their involvement making sure that they can stay in the game with things like the Cadillac Tax. We are likely to see health plans continue to use guidelines, in fact promote guidelines for how healthcare should be delivered, various medical conditions like for example low back pain. And to continue to promote them, because they’ll see the Worker’s Comp and Occupational Health costs go down when those guidelines are followed. That said, of course, the patient-centered initiative that is also a part of the Affordable Care Act that’s dealing with and promoting compared and effectiveness studies, that’s a wild card. We don’t know. They could come out with guidelines that in fact suggest that utilization in Worker’s Comp scenario that pertain to Worker’s Comp scenarios actually go up. And so that’s a little bit of a wild card. Now, all this is contingent on the Affordable Care Act continuing to unfold as it has been designed to unfold in the context of the legislation that’s been passed, and reaffirmed by the Supreme Court. We just yesterday had two Federal Appeal Court contradictory decisions around the legality of subsidizing enrollees that get a health plan using a Federally-managed health insurance exchange. So the key word here is to continue to look at this as a work in progress. Things are still in flux, and so the provisions I’ve just talked about with respect to how things are going to be likely to change, that could alter depending upon how things unfold at the legislative level.
Interviewer: Dr., in light of all this ambiguity, how would you recommend Worker’s Comp and Occupational Medicine professionals get ready for the impact of the ACA?
Dr. Harris Allen: The Affordable Care Act was written and designed with two major goals in mind. One is to reduce the number of the uninsured. The second is to improve the value achieved by the United States Healthcare System; the value here being defined by the outcomes achieved relative to the costs incurred, that ratio, which we in the United States do at best middle of the road on. We spend a lot more money per person on healthcare in our country than all of the other developed countries in the world. Yet our outcomes are no better than average, if not that. Life expectancy at birth for United States citizen is literally 25th ranked relative to all other OECD countries in the world. So we are looking at a need to improve value in healthcare that actually preceded the Affordable Care Act. And it’s going to continue, the impulse, the drive towards achieving greater value. It’s going to actually continue. It’s not going to change. It’s going to go on regardless of whether or not the Affordable Care Act continues.
So in light of that what Worker’s Comp and Occupational Health professionals can do is, number one, recognize that reality and in fact embrace it, in fact, try to step in and try to shape it, if the Affordable Care Act remains a work in progress. Number two, one of the key ways to achieve one of the key aims of the value portion of the initiative, of the agenda for the Affordable Care Act, that is now reducing waste, actually calls for greater coordination of care, and also multidisciplinary sense. So you have a lot of different clinicians out there that now are coming together and in new and different ways, in the context of things like accountable care organizations. And they are figuring out how to collaborate. So what Worker’s Comp and Occupational Health professionals can and should do is become proactive in seeking ways to establish different modes of collaboration with these multidisciplinary teams. That’s the second mode, the second thing that this community can do.
Number three is the whole idea of recognizing the unique contributions that you bring to the mix, this community. And the way I would characterize that in broad terms is that you have a focus on functioning, and role performance; the ability to contribute that is unique among the clinical specialties. And that in fact I would suggest is where bringing compensation for healthcare is headed, not just in Worker’s Comp and disability, but in fact for healthcare in general. We are talking about an interactive process, pulling back the layers of the onion. Right now for example we have outcomes measures that are being used to determine compensation for providers, hospital providers, and ordinary clinical providers in the context of various value-based purchasing arrangements.
Interviewer: Thank you very much.
Harris Allen Jr., PhD is principal of Harris Allen Group, LLC an independent consulting firm founded in 1997 and located in Brookline, Massachusetts. His firm focuses on the measurement and management of health and productivity for employers and health and disease management companies. Dr. Allen has studied, written, and lectured on health care reform and the Affordable Care Act and how it will impact employees, insurers, and occupational health and workers’ compensation professionals. He has previously held scientific, director or managerial posts at the Yale University School of Public Health, Jefferson School of Population Health, Coopers & Lybrand LLP, New England Medical Center, Aetna Life and Casualty, and the Rand Corporation.