Obamacare transforms medical industry

Toledo’s health systems moving toward patient-centered model

Most agree that the Affordable Care Act, commonly known as Obamacare, has fundamentally changed the health insurance landscape in the United States, but the health-care law is also quietly causing a sea change in the way hospitals and doctors treat patients and do business. “The entire industry is really doing a paradigm shift,” said Terri Thompson, vice president of population health for ProMedica.

Leaders at ProMedica and Mercy health systems, the two largest health providers in the Toledo area, are moving away from what they call an outdated model, where doctors get paid for each service provided, to a new one that is broadly known as population health management. Health-care organizations and doctors are being pushed by the federal government to practice more preventative medicine, said Dr. Kenneth Bertka, vice president of physician clinical integration for Mercy. “It used to be you just take care of the patient right in front of you and it was just one patient at a time. Now it’s about managing a community or a population of patients,” Dr. Bertka said.

The federal government is pushing the transformation by offering financial incentives for family practice doctors’ offices to serve as the hub of care for patients — and for doctors and hospitals to work closely together to keep patients healthy. The medical industry’s new term for the doctor’s office serving this role is the patient-centered medical home. The new model would have the primary doctor serve as the head of the patient’s medical team — coordinating with any specialists who are also treating the patient — and spending more time thinking about how to prevent patients from getting sick instead of treating them after they develop a chronic illness.

The Obama Administration announced last week an additional $35.7 million in Affordable Care Act funding to help finance construction of new health centers across the country that focus on this concept. Various federal programs offer doctors and hospitals the opportunity to get paid a percentage of any money saved, if they can show the savings came from keeping people on Medicare and Medicaid healthy instead of waiting for them to get sick.

Go to top