Industry Leaders Share Insights Into Healthcare Reform And The Future Of Healthcare Policy

by Akerman LLP - Health Law Rx

Current events were top-of-mind last Friday, November 15, 2013, as Akerman LLP's Healthcare Practice Group and Wells Fargo invited clients and industry professionals to engage in a thoughtful discussion on healthcare reform and the future of the American healthcare system.

The Healthcare Briefing featured a distinguished panel of executives and legal advisors that included Gordon Bailey, Assistant General Counsel, Florida Blue; Jeffrey S. Bromme, Senior Vice President and Chief Legal Officer, Adventist Health System; Amy Mullen Ellison, Senior Vice President for Employee Benefit Consulting, Wells Fargo; and Kirk Davis, Chair of Akerman's Healthcare Practice Group.

The following summarizes key insights and themes from the discussion.

A. Health Reform: You Can't Unring a Bell

Whether you praise or despise the Affordable Care Act ("ACA"), burying your head in the sand is not an option. The ACA is dramatically changing the landscape of the healthcare coverage, delivery and reimbursement marketplace, and all market participants – providers, payors, employers and consumers alike – must plan for this brave new world. To that end, players in all aspects of the healthcare system have been adapting. Providers have been experimenting with innovative care delivery models to improve outcomes and reduce cost; payors have revised their insurance plan options to conform to the ACA; employers have been weighing their options in the face of the new employer mandate to provide health insurance; and consumers must maintain or sign up for new coverage. Those players who fail to adapt may see their reimbursements cut, lose market share, or be subject to employer or individual penalties. Whether or not the ACA survives in its present form is really not the issue; change has begun, and those ignoring it will be left behind.

B. Significant Changes

Providers: In response to the tectonic shift away from fee-for-service and towards accountable care, providers and payors are beginning to employ new (or previously discarded) business models. For example, many hospitals are vertically integrating by acquiring physician practices and ancillary healthcare providers; providers increasingly are accepting risk models such as capitation and incentive payments that focus on patient outcomes instead of volume of care; and similarly, some groups of providers have joined forces to create accountable care organizations. Providers, especially hospitals, are also navigating new incentives to improve patient outcomes while facing increasing pressure for price transparency. With a continuing shortage of physicians, the industry is using greater numbers of physician extenders such as nurse practitioners.

Insurers: Insurance companies are revisiting the employed provider model and are beginning to compete with hospitals for local practitioner pools. Insurers are also facing administrative challenges, such as pricing plans that cover pre-existing conditions and cover the minimum essential benefits required by the ACA, with very little actuarial experience to develop the prices. They have created new plans to sell on the state and federal insurance exchanges, and they are increasingly focusing on wellness and other preventative care programs. Insurers are also anticipating potential issues, such as the new requirement to continue coverage for 90 days even if a member stops paying his premium, leading to fears that some people could "game" the system. Health insurers and large hospital systems are also trying to work together in a more collaborative approach, again using risk-share features, as opposed to the more traditional, adversarial relationships.

Employers: Employers, another key player in the healthcare industry, are also making changes. Whether large or small, employers are considering the number of full- and part-time employees and balancing the costs and benefits of providing health insurance for those workers. Some are reducing the richness of their current benefits in order to afford to cover more employees. Others are declining to extend coverage to spouses who can obtain coverage from their own employers. Still other employers are preparing to shop on the forthcoming Small Employer Health Options ("SHOP") exchange for what they hope will be better and more affordable plans.

The Consumer: A small number of individuals have managed to learn whether they qualify for subsidies and sign up for new health coverage using the federal Health Insurance Marketplace despite the technical problems with A larger, but still modest group, has enrolled using state-run exchanges or signed up for expanded state Medicaid programs, which were made optional by the U.S. Supreme Court's 2012 ruling upholding the ACA. Other consumers are weighing their options after receiving cancellation notices from their insurers and, following President Obama's recent announcement that insurers may renew non-compliant plans into 2014, determining whether to stay with their current plan or look for a better deal on their state or federal exchange.

C. The Road Ahead

Despite the daily news coverage of the ACA's insurance exchange rollout, many questions remain unanswered. For instance, will enough healthy people obtain coverage to defray insurers' cost of covering pre-existing conditions? Will more states choose to expand their Medicaid programs? What effect will the employer mandate have on small businesses? What effect will the ACA have on the economy as a whole? Will health outcomes improve? The answers to these and many other questions are being formed in real time as all key players in the complex American healthcare system move, full steam ahead, toward 2014.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Akerman LLP - Health Law Rx | Attorney Advertising

Written by:

Akerman LLP - Health Law Rx

Akerman LLP - Health Law Rx on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.


JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at:

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.