Beyond the ACA, Transformed Health Care Lies Ahead

With medical apps, online services and private exchanges, people are taking more responsibility for their own care

By Bill Leonard Nov 6, 2013

By the year 2020 health care in the U.S. will have undergone a radical makeover, and not just because of the Affordable Care Act (ACA). Although many of the changes will be for the better, the tumult in the system will pose an array of challenges to health care plan sponsors and enrollees, according to panelists who recently spoke about the future of health care in a discussion sponsored by Sun Life Financial Inc.

“The health care system in the United States will change more in the next five to seven years than it has in the last 50,” said Jeff Bauer, a health futurist and medical economist, at Sun Life’s Wake Up Summit 2013. “The changes will create what economists like to call a disequilibrium, and those who don’t grasp the way we need to change health care in this country will eventually fall by the wayside.”

The summit, held Oct. 1, 2013, in Needham, Mass., and streamed online, focused on the changing ways in which employers provide health coverage to their employees.

“The timing of the event was coincidental; we had no idea just how important that date would be in the discussion about health care reform,” said Ed Milano, a spokesman for Sun Life Financial. On the day of the summit, state-run health care exchanges created by the federal health care reform law went live while a congressional impasse over ACA funding led to a partial shutdown of the U.S. government.

As controversy continues to swirl around the implementation of health care reform, a dramatic transformation of the U.S. health care system is taking place. During the panel discussion, Bauer noted that the treatments and preventive regimens available in 2013 are vastly different from the way medical care was managed during the latter part of e 20th century.

Technology-Driven Transformations

“Our concepts of who provides medical care have changed over the past 20 years and will change even more drastically by 2020,” he predicted. “The variety of choices we will have in providers will expand greatly as more nurse practitioners, occupational clinicians with Ph.D.’s, and clinical pharmacists assume roles and responsibilities that we haven’t seen before.”

Online delivery of health care will be another tremendous change, and Bauer pointed to the growing number of people who use services such as and WebMD.

“With the number of medical applications that are now being developed for smartphones and personal computers, people will be using these to monitor their conditions and take more responsibility for their own care,” Bauer said. “These developments are going to radically change the way many of us interact with health care professionals. Patients will be able to monitor their own conditions and vital signs—like blood sugar, temperature, pulse rate and blood pressure—with scanners and software applications that are now being developed for smartphones and computer tablets.”

Medical apps for smartphones and other devices will allow people to monitor their conditions and interact with health care professionals.

In addition, health care consumers’ expanded responsibilities will include selecting health care coverage from a growing array of options, panelists said. Although the federal health care reform law is one reason for more health care insurance choices, an effort among employers to reduce the cost of providing health care benefits is another driving force for this change.

The federal- and state-run health care exchanges, or online marketplaces, created under the ACA have expanded the coverage possibilities available to individuals who don’t receive health care benefits through their employer. What’s more, a number of private exchanges are coming online and are offering businesses and their employees a new way to shop around for better health care deals. People need to be aware that the private and public exchanges are separate entities and shouldn’t be confused, the panelists explained.

“The sheer number of options now available through these exchanges, and the number of options that will become available over the next five to seven years, is a tremendous change from just a year ago,” commented Jonathan Gruber, professor of economics at the Massachusetts Institute of Technology and director of the health care program at the National Bureau of Economic Research. “We are going to see a much more level playing field in consumer access to health care benefits, and consumers will have much more choice in what their coverage will be.”

New Role for Employers

This expansion in benefits options will alter companies’ role in providing medical coverage to their workers, according to Gruber.

“Consumers will be empowered with more choice,” he said. “They will go to exchanges, select what plans they want, what their deductibles are and what care they want to use. The employers’ role up to this point has been to provide the health care plan and protect employees from making bad choices. So now, the question is just what role employers will choose to have in protecting their employees from bad health care choices.”

Responding to Gruber’s point, Coleman Peterson, former HR chief for Wal-Mart, said employers are shifting away from helping workers choose what health care coverage works best for their families and focusing on wellness programs. It is a more holistic approach, Peterson said, which is “transforming employers’ environment of care for their workers.”

“The employee/employer relationship isn’t going to radically change overnight,” he said. “But what is changing rapidly is just how employers are providing the benefits that employees want and need. The transformation we’re now seeing is creating a more holistic approach in which employers help employees make better lifestyle choices that will lead to them living healthier, happier and more productive lives.”

Bill Leonard is a senior writer for SHRM.

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