NORTH BAY -- Health care reform is here to stay and employers must adjust quickly in order to meet compliance with the complex law, whether they find it politically palatable or not.
Providers, meanwhile, are themselves rapidly adjusting to new incentives and payments under the law, resulting in transformational changes that will begin to address, though not completely solve, some of the high cost curves seen over the last decade.
That was the prevailing theme at the Business Journal's Health Care Industry Conference, "What now? A post-election discussion of health care reform," held last week at the Hyatt Vineyard Creek in Santa Rosa. It featured a host of regional insurance experts and health care providers who detailed intricacies of the law after President Barack Obama's re-election all but assured a new era of health care delivery, how it's paid for and how employers will need to address benefits.
Yet, while the Affordable Care Act is a reality, not all employers -- and particularly smaller employers -- have moved quickly enough to rethink their strategies on how or even if they pay for employee benefits in the very near future, brokers said.
"It's going to have a big impact on many aspects of society, but there is a lot of confusion," said John Fradelizio, managing director of employee benefits for Wells Fargo Insurance Services in Petaluma.
Added David Hodges, vice president of Santa Rosa-based Vantreo Insurance Brokerage: "It's real and it's serious. If you have 50 or more employees you need to talk with one of us."
For providers, there are some gains coupled with uncertainty.
Despite lowered reimbursements for care from the federal government to the tune of 10 to 15 percent, hospital leaders said the bill's shift to primary care -- as opposed to specialty and emergency care and other high-cost treatments -- will benefit both the industry's bottom line and improve health outcomes, a point that was echoed by some brokers who touched on getting the population healthier in effort to curb utilization costs.
"It's a mutated form of health reform, but it's nevertheless a model that allows us to care for people," said Mike Purvis, chief administration officer of Sutter Medical Center of Santa Rosa.
That view was echoed by other hospital and health plan representatives from Kaiser Permanente, Western Health Advantage and St. Joseph Health, who said the focus must now include integration between plans and providers to keep patients out of a hospital setting unless it's truly warranted.
Case in point: the recent alignment between Sacramento-based HMO Western Health Advantage and area hospitals, Memorial being the largest, that will provide employers more choice in providing benefits. It also coordinates care between Marin, Sonoma and Napa counties, with the help of Novato-based 600-member Meritage Medical Network in a manner that mimics Accountable Care Organizations encouraged under the ACA. Such alignment is seen as a step toward better communication among providers, which in turn is aimed at better health outcomes, less hospitalization and less redundant procedures.
"We're growing expansively outside of the hospital in really preparing for health care reform," said Todd Salnas, president of St. Joseph Health, Sonoma County, which operates Santa Rosa Memorial and Petaluma Valley hospitals, as well as numerous clinics and home care in the region.
Both Mr. Salnas and Mr. Purvis, of Sutter Health, touched on the topic of home care and hospice, which they said will come more into the spotlight in an effort to address costs and utilization as the patient population gets older.