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Who needs SCOTUS?

I stood at the steps of the Supreme Court on Monday, March 26th for the first day of oral arguments debating the constitutionality of the Affordable Care Act.   It was wild to see all of the television cameras, national and international media, the sea of white coats standing in support of the ACA and the Tea Party members chanting “We love the constitution.”  I tweeted all day under the hashtag, #Obamacareapalooza! 

The spirit was exciting and encouraging that Monday, until the pundit class began speculating about the language they heard inside the courtroom.   Some pundits labeled it a “train wreck” for the ACA.   Of course, since the oral arguments have ended, there is no shortage of opinions and conjecture, and some opinions are far less chicken-little-the-sky-is-falling and a bit more measured.

Alas, the oral arguments are over.  The nine Supreme Court Justices have voted, behind closed doors, and assigned the writing of the majority and dissenting opinions, and we will get to know what they decided likely in June.  At this point, after reading a thousand opinions about how they will rule, I don’t want to read any more about it unless it is written by a bona fide mind-reader who can tell me what 9 SCOTUS Justices are thinking. 

But I do know one thing – regardless of their ruling, the Affordable Care Act has already altered the way the health care system works for the better, and will continue to do so for years to come.  I know this because of the meeting I had with a registered nurse the Friday before the oral arguments began.

This wonderful nurse works for Carefirst, a private health insurer in the Blue Cross/Blue Shield family.  We sat for about an hour discussing a new program the insurer is working on, known as their Patient Centered Medical Home (PCMH).    She described to me how it works: Carefirst will help me, through analyzing claims data, identify who my most sick patients are.  I will then invite those patients into my office for an extended visit to develop a comprehensive care plan.  This comprehensive care plan will include a detailed analysis of preventive targets met and missed, diet and exercise plans, disease specific plans and goals, and screenings for depression and substance abuse.   For this, Carefirst will reimburse me roughly 2.5 times what an average office visit reimburses.  If a patient is willing to voluntarily enroll in the PCMH, they will be able to have quarterly visits with me to update that care plan (again, reimbursement to me is higher than any office visit previously) along with any other routine office visits AND have WEEKLY calls from this nurse at Carefirst to help motivate the patient to stay on their care plan.  The goal is to have the primary care physician be a true medical home for patients who need better coordination of care – especially those who have multiple chronic illnesses. 

The ACA seeks to advance development of Patient Centered Medical Homes and Accountable Care Organizations, and already private insurers like Carefirst and health systems like Georgetown-Medstar are advancing these initiatives.   The ACA established the Center for Medicare and Medicaid Innovation which will be a game-changer in health services delivery, and work towards fixing our fractured and fragmented health system to better meet the health needs of all Americans. 

Regardless of what SCOTUS has decided, the Affordable Care Act has made an indelible mark on our health care system.   It is up to health professionals to advance this progress, no matter what SCOTUS decisions are made known in June.  If you need any inspiration or validation of why this is the better direction to head in, watch this

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  1. owen linder

    Thank you for being level headed and informative.
  2. Ram Krishnamoorthi

    This is a great story and example of how the "government intervention" has actually motivated the private insurer to adopt more sensible practices BEFORE the actual intervention has even taken place. if the ACA is struck for it would be a huge setback, but it's good to know it has helped the forward thinking actors in the private sector.
  3. Scott Poppen MD

    Yes. No matter how the court rules, the ACA has already improved access, certainly has saved some lives, improved quality, and has permanently enshrined positive changes in our health systems.
  4. Chris Lillis


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