The federal health care reform law — known as the Affordable Care Act — is sparking a vast array of changes across Maryland and the nation.
More providers are joining together to better compete with larger hospital networks and cut costs, while more people are at least trying to obtain coverage through exchange networks that have gotten off to a rocky start since rolling out in October.
Last month, Gaithersburg-based Adventist HealthCare started operating the Mid-Atlantic Primary Care Accountable Care Organization, an entity designed to improve the coordination of medical services and reduce costs. It is one of more than 100 nationally approved by the federal agency Centers for Medicaid and Medicare Services to participate in a shared-savings program.
Adventist has long been working on ways to reduce medical costs and serve patients better, said Patrick Garrett, chief administrator of the ACO and senior vice president for physician integration and population-based care with Adventist. In that regard, the federal law is not a driver in developing the organization.
“Many trends in medicine preceded the [Affordable Care Act],” Garrett said. “For many years, we have been taking on more responsibility to obtain better outcomes.”
The physician-led partnership includes more than 1,000 providers, ranging from individual physicians to larger physician groups such as MedPeds in Laurel and Comprehensive Women’s Health in Silver Spring. Adventist’s facilities include Shady Grove Adventist Hospital in Rockville, Shady Grove Adventist Emergency Center in Germantown and Washington Adventist Hospital in Takoma Park.
There are more than 100 primary care physicians and 14,000 patients in the region within Adventist’s ACO, mostly in Maryland. While providers in the organization do not share facilities and resources, they can reduce costs through, for example, avoiding duplication of lab tests and services, Garrett said.
“It helps us create more efficient and coordinated care,” he said. “It does take a lot of coordination. … But we think this is a big part of the future of health care, working with our community physicians.”
Another way Adventist is working to improve care is by establishing more preventive care clinics. Along with Community Clinic Inc., the company recently opened a new clinic at its Takoma Park hospital that focuses on uninsured and underinsured patients.
Federal researchers project that spending by Medicare will slow in the coming decade, breaking a trend in past decades of that spending being significantly higher than the rate of growth of the economy.
Maryland’s health care exchange, through which some people have obtained insurance, is still plagued with inefficiencies to the point that U.S. Rep. John Delaney (D-Dist. 6) of Potomac and others continue to ask that the state switch to the federal health insurance exchange while Maryland’s system is being fixed.
State health officials said in a report last week that many of the technical glitches “most frustrating to consumers have been fixed, and we continue to work to address others that continue to cause difficulties for some Maryland consumers.”
The state system had signed up 29,059 Maryland residents in private health plans, as of Feb. 1. More than 140,000 residents had been enrolled in Medicaid, either automatically or through the site.
Maryland is one of 16 states, along with Washington, D.C., operating their own exchanges. Others like Virginia have residents use the federal government’s system.
U.S. Sen. Benjamin L. Cardin (D) of Pikesville, who recently toured the Bethesda headquarters of Wellness Corporate Solutions, which provides corporate wellness programs for public and private clients, said he was not happy with the start of Maryland’s exchange system. But he was told that moving to the federal system even temporarily would cause transitional issues such as problems with people in the middle of their application process.
“The state has considered multiple changes, including moving to the federal exchange on a temporary basis,” Cardin said. “They are interested in getting health care coverage to as many people as possible. But they say that moving right now to the federal exchange would be counterproductive.”
Wellness Corporate Solutions provides a good model to help employers bring down medical costs by working on the prevention side in helping employees stay healthy through exercise and better nutrition, Cardin said. He has promoted wellness programs within the federal government and also serves on the Small Business and Entrepreneurship Committee.
“It’s a very impressive company,” Cardin said. “Everyone seems happy and wants to get to work. And it’s growing fast.”
Wellness Corporate Solutions moved to its Bethesda location last fall from a smaller space in Cabin John. The company has more than 80 employees and last year made Inc. magazine’s annual list of the 500 fastest-growing private businesses nationally. The business ranked 355th with a revenue growth rate of 1,237 percent between 2009 and 2012, to $9.3 million.
While employers investing in wellness programs reap financial benefits over time, it’s sometimes a struggle to demonstrate a clear return on investment, said Fiona Gathright, president and CEO of Wellness Corporate Solutions. It takes several years to collect the necessary data and foster a true culture of health in a workplace that promotes lasting results, she said.
“But we’ve found that even at the outset, employers reap a number of benefits from wellness programs,” Gathright said. “Employee morale improves markedly, and as employees become healthier, absenteeism rates decline and levels of productivity increase.”