Businesses along the spectrum of the county’s healthcare industry are keeping up work after a recently announced delay of a major part of federal healthcare reform.
The Obama administration said in early July that it would delay until 2015 the Patient Protection and Affordable Care Act’s employer mandate, which requires midsize and large businesses to offer health insurance coverage to their workers. That portion of the law was originally scheduled to take effect Jan. 1, but the Treasury Department announced it would delay it a year after hearing from employers about the challenges of its implementation.
The Business Journal’s Vita Reed asked four people in the healthcare industry what they’re doing, now that full implementation of reform has been delayed. Edited versions of their answers follow.
Diane Laird
Chief Executive
Greater Newport Physicians/Nautilus Healthcare Management Group
Newport Beach
We do not anticipate the delay to have any impact on [Greater Newport Physicians’] operations. However, I do believe that the delay will provide much-needed time for businesses to ensure they can comply with all of the new reporting requirements and make the best decision for their employees.
Greater Newport Physicians believes the primary objective of the Affordable Care Act is to provide increased access to affordable healthcare. To that end, [we are] continuing to invest in programs which improve the health of the population we serve and ensure access, quality and personalized care for our members when they are ill.
While we have a 28-year track record of providing outstanding care to Orange County residents, we know that we must continue to innovate to make healthcare more efficient and convenient at the same time as it’s continuing to improve the patient outcomes.
As an example, we have invested millions of dollars to install electronic medical records in the majority of our private physicians’ practices, which improves communication with their patients, as well as other physicians. It also provides physicians with immediate remote access to their patients’ charts so they can make better decisions when their patients call them after hours. In addition to helping our physicians connect with their patients via secure email communications, we are exploring new technologies to allow our physicians to communicate via secure texting to quickly expedite specialty consultations and overall patient care.
We have also developed specialized clinical programs for patients with chronic conditions to help them optimize their health. Our Active Diabetes Program, for example, is getting rave reviews from both our physicians and our most complicated patients, who are thrilled with the team approach, which offers them coaching and additional support to manage their diabetes and improve their lifestyle.
Last year, GNP affiliated with MemorialCare Health System in order to partner with an organization that has a similar track record in its commitment to provide quality affordable care to the community. In partnership with MemorialCare, GNP has added nearly 500 primary care and specialty physicians over the last 18 months in order to expand our geographic coverage to provide more convenient access to coastal and inland Orange County residents, from San Clemente to Long Beach.
Karen Nixon
President, Founder
Nixon Benefits
Newport Beach
The delay of the penalty imposed on large employers if they do not provide adequate and affordable health care coverage has had little to no effect at this stage of implementation. While employers will not face a penalty for not providing coverage in 2014, most employers have already made the necessary adjustments to their benefits program in order to conform to the new rules. For instance, many employers already altered their benefit eligibility to meet the Patient Protection and Affordable Care Act’s minimum requirement of 30 hours per week. Unfortunately, this has adversely affected many workers, with reduction in hours and outsourcing jobs.
By delaying the large employer requirement, the administration has provided more time to allow for those employers who are not yet prepared. However, this delay may have created more headaches for underinsured employees.
Part of the delay includes the requirement on employers to report to the IRS, detailing if their coverage meets the required guidelines. This reporting is intended to assist the IRS in determining which individuals may be eligible to receive a subsidy. If an employee is not covered by affordable or adequate coverage, then he or she may qualify for premium assistance. But since this reporting requirement has been delayed, it will be more difficult for the IRS to identify those that are eligible for a subsidy and to prevent fraudulent activity.
As benefit consultants and brokers, Nixon Benefits focuses on the issues which affect each of our clients. We have increased our Compliance Department, as well as expanded the number of attorneys and CPAs with whom we partner. Much time is spent preparing every client and setting the right strategy for each one; no business is alike.
Lee Penrose
Chief Executive
St. Jude Medical Center
Fullerton
The delay will not change how our organization is preparing for the delivery of healthcare services going forward.
During the past few years, the phased implementation of the Affordable Care Act has caused us to take a broader look at our organization to determine ways we can become more efficient with coordinating patient care needs in a highly focused manner.
We’re now investing more resources toward patient outreach and population health management, especially with higher acuity patients, to ensure people are getting the care they need.
Our view is that healthcare reform is more dependent upon the physician practice capabilities and outpatient facilities to better coordinate care for the patient population. This has resulted in the need to develop systems so we can segment the population into primarily three categories: high-risk patients; patients who need minimal case management; and the healthy population that we need to keep healthy.
Key areas for high-risk patients we’ve been initially tracking are patients with different types of diabetes, congestive heart failure, and chronic obstructive pulmonary disease.
To accomplish these objectives, we’re making significant investment in our infrastructure so we can better understand and manage these three patient population groups prospectively. We’re implementing new technologies, including a risk stratification and predictive modeling tool to better understand and analyze our patient populations. We’re also investing significantly in staffing by hiring RNs who are solely focused on care coordination for patients with chronic disease and building care teams around the providers. We are also engaging social workers and pharmacists where appropriate so they all can help with better outreach and coordination of patient care needs.
In addition, with our recent affiliation with Hoag Hospital, we have created a regional integrated delivery network where patients can be referred to any physician in our medical groups, physician networks or hospital-based outpatient services.
We’re also expanding and adding physicians to our networks, such as with the recent addition of Mission Internal Medical Group.
Overall, we’ve added more than 100 physicians to our networks and groups during the past year. We plan to add a similar number in the coming year as we expand our physician accessibility throughout the county to ensure patients get the right care at the right time, in the right setting.
Julie Miller-Phipps
Senior Vice President, Executive Director
Kaiser Permanente Orange County
Anaheim
It is important to note that the government is only delaying one aspect of health reform with minimal impact, since most employers with more than 50 workers already offer their employees health insurance.
Federal officials have announced their intention to allow an additional year before some of the ACA’s employer and insurer reporting requirements go into effect, including the tax penalties for failure to provide the required affordable health benefits coverage in businesses with more than 50 employees.
This delay will not affect the operations of Kaiser Permanente hospitals; we re-main committed to supporting our bus-iness customers and members as we work to navigate the requirements of the ACA.
