October 1, 2013: A Day to Remember

Man walk among bearberry rice“A 1000 Mile Journey Begins With a Single Step.”
(Lao Tse

In many facets of and at various times in our lives there is day we will always remember. Some are very personal, others a part of the world around us.

October 1, 2013 marks considerable effort if not meaningful progress in the effort to provide better, affordable health care. Leave the acronym ACA and associated politics in the background and be sure this commentary does not position it as a panacea. But it is a step or a series of steps in a journey the purpose of which is hard to argue against.

On October 1, 2013 hundreds if not thousands of State HHS and IT professionals should take pride in their efforts and be applauded for them. Among a number of steps, Health Insurance Exchanges (HIX)  will be deployed to allow more people to acquire health care insurance.

I was at a Medicaid conference in Charleston, SC recently. Two things really stood out  after I spent two days with some of these folks, very focused on the then looming deadline of 10/1/2013 for compliance with the Affordable Care Act.

First, a keynote presentation by the author of  “Catastrophic Care: How American Healthcare Killed My Father – And How We Can Fix It.”  (David Goldhill, Knopf Publishing 2013). The title is eye catching. The presentation produced  an alarming sense of a system at best imperfect if not just waiting for “bad things” to happen in terms of both care and insurance issues.  If my beloved father were still alive I would have been out of that conference room in an instant, checking on the healthcare that would be available to him when/if needed and at what cost.

One of the messages from the presentation was that waiting until healthcare insurance is needed would be close to a death sentence for many as “the system” would not respond in time. To be clear, this book is not an endorsement of ACA, far from it. But it expands the discussion beyond laws and having more people with coverage to better care and systems to ensure that.  Already insurance policies provide for preventive procedures for women that often might have been delayed due to the cost. That’s a step (driven by ACA) in the journey to better, more affordable care.

Second, IT– the people and the technology– really can make a difference. One night, I encountered a state delegation of HHS and IT management at a lovely Charleston restaurant where I often dine. I knew one of the delegation members, their advisor and an industry thought leader in these matters, and asked if they were celebrating. He said “you betcha…and it’s something you and I both believe in, the ability of IT to help put “Policy into Practice.” The state was going to meet if not exceed some of the key milestones for 10/1 with a sense of pride that their citizen-centric focus was going to provide better services.

Another state presented a conference session on its approach to meet 10/1 deadlines by “stitching together legacy IT systems.” A bid awarded to a very capable Systems Integrator for a modernization project was scuttled by politics so HHS/Medicaid IT personnel had to fend for themselves. The pride a State Director took in telling their story was admirable. He also added that they were able to re-purpose one software product that had been licensed for the overall modernization effort and used it to build a very effective MAGI (modified adjusted gross income) capability for a key system. Another step in the journey to provide the right care to the right people -and he even used the title of this blog to describe what the technology got them doing – thinking in rules.

I hope for many of the people I met and all the others toiling away as 10/1 approaches that it’s a day each of them will remember, take pride in. It is a day on which at least parts of a public policy will have been put into practice. Perhaps subtle and not affecting us all, particularly those more affluent or fortunate to be covered by employer health care insurance plans.

One of my healthcare providers took an interesting approach recently  with an email subject line – “Schedule Your Colonoscopy Soon- Now Covered Under Your Insurance Plan (due to ACA)”.  Hmnnn. No pain, no gain? Now that procedure is not in practice all that painful but thinking about, preparing for it can be uncomfortable at least. But a policy of encouraging preventive care is the right step.

So too with further efforts for advances in a better US Healthcare System so “no more fathers are killed by it.” The journey is hard.  There will be discomfort.  But the destination is right and for these admirable HHS and IT professionals, the reward is the journey.  For them at least, 10/1/2013 is a Day to Remember. Well done, public servants.

The journey continues…

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