Rohan Kulkarni, vice president of healthcare strategy and portfolio at Conduent,speaks here about Conduent’s healthcare strategy and the company’s move to brand following its separation from Xerox. While doing so, he steps back to look briefly at aspects of healthcare technology’s past then pivots to its future and what he’s most excited about in the space and how he hopes to be part of it. Finally, he describes wheat he would pursue if he were healthcare’s king, and what that would look like and how he would change the sector for the best impact to the patient.
You’re the vice president of healthcare strategy and portfolio at Conduent. Can you explain what the role entails, and how you approach it?
The transformation in healthcare that is occurring is generational and provides for unprecedented opportunities. As the head of healthcare strategy, I am responsible for identifying those opportunities that are relevant to us and help strengthen our portfolio. I then design and develop a strategy in collaboration with our business leaders that will help meet our growth goals.
Tell me how Conduent plays in healthcare and how its solutions specifically impact the point of care.
Conduent has perhaps the broadest solutions portfolio in the healthcare services, allowing us to connect the entire healthcare ecosystem.
Conduent provides solutions that help our clients overcome industry obstacles, including inefficient processes, inaccessible data, regulatory mandates and challenging economics so they can focus on improving patient lives through better, affordable, accessible healthcare. Our solutions are all designed to help our clients manage the health of their patient populations so they can improve healthcare outcomes. We help make the transition to value-based care models a reality, and we work with healthcare professionals to design solutions that meet their specific needs.
Conduent is dedicated to the efficiency of claims accuracy, facilitating bill payments and risk assessments, communicating benefits, driving medication adherence, improving patient engagement and technology education, and delivering on quality and care data across medical systems. Our solutions are designed to reduce preventable readmission rates for defined population sets, control costs by executing proactive engagement and provide ongoing management for patients with chronic conditions.
Conduent just completed its separation from Xerox. What does that mean for your company and for your customers? Why the move and why the rebrand? Why not build on the power of the Xerox brand?
When reviewing the products and services offered across the business, we determined creating two independent, standalone entities – Xerox and Conduent – would give us the ability to create greater shareholder and customer value. The separation is based on a structural view of two of our businesses and with simpler, more focused organizations, we’ll be able to adapt to market demands and ensure we’re positioning the business to deliver tailored solutions based on our clients’ evolving needs.
How has healthcare IT transformed throughout your career? How has Conduent been involved in healthcare’s evolution?
I think most of the healthcare industry expected healthcare IT to be a driving force in improving how providers deliver solutions to their patients, but I don’t think we expected the rate of change to be so dramatic, especially over the last decade or so. We’ve seen vast improvements in how providers use health IT with the advent of electronic health records, mobile health technologies, telemedicine, wearables, analytics, etc., to improve communication with patients, personalize care and drive healthier outcomes. Since our introduction to the healthcare space, we’ve been helping businesses and governments better harness the influx of information to enable transformation. From the back office processes like billing and payments, to using Big Data to drive medication adherence, assessing risk and improving patient engagement, our solutions meet today’s challenges and prepare healthcare organizations to meet tomorrow’s needs.
What are you most concerned about in regard to healthcare’s future?
Healthcare economics continue to be single dimensional in that the focus is on the demand side, i.e., insurance. The Affordable Care Act (ACA), while it has streamlined the demand side, it has not addressed supply side, e.g., hospital charges, cost of medication etc. in any meaningful manner. As such, much of the debate in the public domain about healthcare is unlikely to make progress until both sides of the equation are discussed.
For years, major healthcare and patient safety organizations in both the public and private sectors have discussed how patient identification errors have led to medical emergencies and patient harm in hospitals around the globe. This situation has been mitigated to some degree by the use of barcode print and scan technology.
In this Q&A, David Crist, president of Brother Mobile Solutions, explains how today’s newer and more innovative mobile technology can empower physicians, nurses and technicians to improve patient identification procedures to reduce errors and improve the quality of patient care. Anton Ansalmar, founder and CEO of Rapid Healthcare describes how one application of advanced mobile technology at the actual point of care has successfully identified and prevented potential breast milk misfeed incidents in a U.S. hospital’s busy neonatal intensive care unit (NICU).
First, how do today’s mobile patient ID and verification solutions serve to reduce risk and enhance patient safety and regulatory compliance risk in hospitals and other clinical healthcare environments?
Crist: While most hospitals use barcode scanning and wristband printing systems for incoming patients, many are not leveraging mobile technology to its fullest potential. Today’s next-generation patient identification and authentication solutions use on-demand wristband and label printers help to ensure optimal accuracy and patient safety at all points of care. These wireless mobile systems enable caregivers to administer care whenever and wherever it is needed throughout the facility.
For example, nurses can take samples, infuse blood or administer medications and, at the same time, print out or verify the patient wristband and print a matching label for the samples, blood and medication bags. The matching wristband and labels contain legible human- and machine-readable data (barcode plus text). Following these patient identification validation and authentication procedures at the actual point of care—whether in the ER, operating suite, or at the bedside—not only saves time and improves efficiency, but also significantly reduces the risk of misidentification and human error. It also helps ensure the hospital’s compliance with EHR regulations and the five rights of patients: the right patient, right drug, right dose, right route, and right time.
What are some of the problems created by patient misidentification, and how pervasive are they in today’s healthcare system in which virtually every hospital and ambulatory care center uses patient ID wristbands upon admission?
Crist: Even though patient ID wristbands are pretty much universal, at least in the U.S. and other medically advanced nations, incidents of misidentification are still more common than you’d think. For example, a 2016 article in Beckers Hospital Review cites an ECRI Institute report which states: “Failing to associate the right patient with the appropriate action, referred to as wrong-patient errors, is a prevalent occurrence with potentially fatal consequences.” The article notes that ECRI examined more than 7,600 wrong-patient events occurring from January 2013 to July 2015 and found that about nine percent of these had led to temporary or permanent harm or even death.
The study notes that more than half of the wrong-patient events involved either diagnostic procedures or medical treatments. Had these healthcare providers employed mobile patient ID and authentication procedures at the actual point of care, perhaps most of these wrong-patient incidents could have been avoided.
Ansalmar: Misidentification problems are global in scope as we learned in conducting market research for our Mother’s Milk mobile application for patient identification and authentication. We found numerous international reports of errors related to the misfeeding of bottled breast milk to premature and at-risk newborn infants. For example, in several Australian hospitals where the wrong bottle was given, the error was quickly discovered, but the infant’s stomach had to be pumped to prevent a potentially adverse reaction.
These kinds of incidents clearly show why patient identification and verification is so important. It is especially critical for premature infants and full-term babies born with conditions requiring intensive care, because their delicate systems can be harmed or compromised by being fed the wrong bottle of expressed mother’s breast milk.
What is the Mother’s Milk mobile application and why was it developed? Is the app being used by any hospital here in the U.S.?
Healthcare is experiencing major breakthroughs in technology with the rise in digital transformation. mHealth – a terminology that combines mobile technology with healthcare is proliferating and bringing up an opportunity to revamp public health.
Mobile technology is playing a vital role in delivering healthcare seamlessly, with ease of access to both providers as well as consumers.
The magnitude and scope of development of mHealth is beyond explanation. As per GreatCall, mHealth is projected to be a $26 billion industry by the end of 2017. Surely, 10 years from now healthcare mobile devices will become smarter than they already are.
This technology has a potential to reduce the risk of errors and save the time and money that is often wasted. As more and more care providers are shifting to mobile health technologies, consumers have a plethora of options to choose from. Its adoption rate is at an all-time high since it has a variety of utilities to offer.
Development of point of care medical devices, fitness and wellness smartphone apps, clinical medication apps, medical resources, journals and patient records is on the surge. Mobile technology is helping increase patient engagement and connected care. Almost, 83 percent physicians believe in the power of mHealth for patients.
There is a whole new world of possibilities and challenges that mobile has opened for healthcare along with its growing development and support. For instance, end point app security, data breaches and HIPAA violations have sharply increased and there is a need to regulate them. Despite these, mHealth proves to be the most promising industry trend for caregivers and consumers alike.
To understand the general consumer response, usage trends security concerns governing mHealth, Kays Harbor has come up with an infographic. This infographic depicts interesting facts and numbers reported by surveys conducted by firms like SkyCure, Research2Guidance, Great Call, etc.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
The US healthcare is getting costlier every day, and it is without a doubt true that most of the US citizens live in fear that they won’t get access to the care when the illness strikes. The sad truth is that every year more than 100,000 deaths occur because of medical errors. All this when we see horrifying figures even after adjusting the America’s higher per capita GDP; US spends roughly $500 billion more than other developed countries.
The Problems with Coordination
13 years ago, way back in 2003, the Institute of Medicine had identified the most persistent problem in the healthcare industry, and it was coordination. The idea behind implementing EHRs was to create digital data that is easy to share, but that did not happen. According to a study, 63 percent of primary care physicians and 35 percent specialist are not satisfied with the information they receive from other physicians within the adult referral system.
The above graph shows how poorly coordinated care has affected the adults. The US stands second when it comes to high-need patients. This is when US spends more than $10,000 on one person’s health.
According to a research article, the biggest challenges Primary Care Physicians and Hospitalists faced were:
Difficulty reaching out other clinicians
Lack of information feedback loops
Lack of general information like clarity on test results, history, and medications, etc.
Insufficient access to discharge information of patients
Working towards a solution
Besides these, a lot of problems arise when patients miss out on medications, follow-up visits or any other requirements. Thus, there is a need to create a process where neither do PCPs miss out on critical information nor does the patient stay unaware of the care plans. For this PCPs had identified the most successful care coordination components:
Better coordinated care for at-risk patients
Enhanced direct contact with patients through phone calls
Advanced use of EHRs for better health information exchange
Developing better interpersonal relationships
Health coaches connecting care
The most important aspect of healthcare is that when a care process is nearing its end, the patient should be in a better state. A patient-centric approach is must to make sure a patient gets the best treatment. Health Coaches ensure that the patients get what they need. They make sure that the
Patient doesn’t miss out on his medications
Patient attends follow-up visits,
Patient has no transportation barrier while visiting a hospital
Inform family/caregiver about the care plans and the patient
Track and make sure adherence of care plans
Review discharge instructions
The Three Pieces of Care Coordination
More often than not care coordinators miss out on the essential information about the patients. In worst cases, they have no discharge information of patients creating gaps in care and indirectly increases the cost of care. Ideally, the three pieces of care coordination together can bring dramatic improvements in patient-centric care. The three pieces are:
When we talk about technology disrupting healthcare, we aren’t just referring to changes in the accuracy of health records or the convenience of mobile care; the real disruption comes in the form of fundamental challenges to traditional scopes of practice.
What Should We Do?
Scope of practice, broadly, is determined by a combination of liability and capability. Lead physicians carry greater liability than the bedside nurses assisting in patient care, because the care plan is directed by the lead physician. Likewise, the extra years of education and practice are assumed to increase the capacity of physicians to lead their care teams, make decisions about how the team will go about its work, and parse all of the information provided by the patient, nurses, and other specialists involved with each case.
In every other industry, productivity increases come from technology enhancing the ability of individuals and teams to perform work. Email saves time and money by improving communication; industrial robotics standardize manufacturing and raise the scale and quality of output. Every device, app, and system allows individuals to scale their contribution, to do more and add more value. Word processing and voice-to-text enable executives to do work that might otherwise have been performed by a secretary or typist. Travel websites allow consumers to find cheap tickets and travel packages that would previously have required a travel agent to acquire.
In healthcare, technology is changing the capacity of the individual caregiver, expanding what can be done, and often how well it can be done. These improvements, along with a growing need for healthcare professionals and services, are challenging traditional notions of scope of practice–for good and bad.
Some of the changes to scope of practice are positive, necessary, and constructive. For example, technological literacy is necessary at every point in the care continuum, because interoperable EHRs and the vulnerability of digital information means that everyone must contribute to cyber security. In a sense, caregivers at every level must expand their scope of practice to incorporate an awareness of privacy, security, and data management considerations.
By extension, all caregivers are participating as never before in the advancement of clinical research, population health monitoring, and patient empowerment simply by working more closely with digital data and computers. As EHR technology iterates its way toward fulfilling its potential, caregivers and administrators are being forced to have difficult conversations about priorities, values, goals, and the nature of the relationship between patient, provider, system, and technology. It is overdue, and foundational to the future of healthcare.
Is There A Nurse in the House?
The trend in healthcare toward prevention and balancing patient-centered care with awareness of population health issues puts primary care in a place of greater importance than ever. This, in turn, is driving a shift in the education of nurses to promote more training, higher levels of certification, and greater specialization to justify relying on nurses to fulfill more primary care roles. They are becoming better generalists and specialists, capable of bolstering teams as well as leading them.
The advancement of diagnostic technologies and understanding of the nature of disease, illness, and genetics has also thrust the clinical laboratory into the center of healthcare. It doesn’t necessarily change the scope of practice for the laboratory scientist, but does elevate the demand and scale of operations for these professionals must fulfill. Once again, the broadening demand has dovetailed with an effort to broaden the scope of practice for other clinical roles, particularly nurses.
Whether it is appropriate or practical for nurses–already understaffed and overextended–into all these critical blended roles is open for debate.
Man, Machine and Medicine
While cross-training is valuable for improving collaboration and breaking down siloes–both critically important to the future of healthcare–it blurring the scope of practice or between roles that comprise very different skills and responsibilities. Technology is expanding the capability of every clinical and non-clinical role, but is it not entirely clear whether it is keeping up with our expectations and demand for the people in these roles.
In addition to answering these questions about scope of practice, we need to look carefully at how technology can change the scope of accountability for patients. Technology may be a platform for engagement, but getting real patient participation requires a better foundation of health literacy–just as caregivers must develop a more robust technological literacy to take advantage of EHRs.
About two decades ago who would’ve thought of the invention of Nano robots that are able to carry drugs all the way to the human bloodstream?
It’s happening. Technology is revolutionizing the conventional ‘human country doctor’ health care and there’s not much to be surprised of. With modern machines and software taking over the healthcare industry, one often wonders, “What good is technology doing to it?”
Health information technology (HIT – is information technology applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors) is the burgeoning specialized combination of information technology, communications, and healthcare and it is altering the course of patient care for the better. Here’s how:
Practicing medicine is a lifelong learning. Doctors need to be on their toes all the time to acquire the knowledge of the latest developments in their field. Not updating themselves can make their practice stagnant – nobody would want to consult a doctor like that. Health IT brings the knowledge about everything, be it patients, therapies, diseases or medicines at their easy disposal. This knowledge can be easily shared between consultants, patients, and can even be updated when needed. That’s a whole new world of medical science for the doctors and patients to explore.
The world is swiftly moving towards specialization. Healthcare is no different. A single hospital stay could mean being under the observation of several different specialists at the same time. These specialists are required to coordinate with each other on every case they deal with. The way forward is paved by health IT. Health IT helps bring everything related to your condition from nutrition to neural complications in tandem with each other. The specialists know which condition can make regular course of treatment difficult for you or which medicine would trigger your skin allergies. The result? There are fewer chances of problems arising in your healthcare.
The most significant way IT is transforming the healthcare industry is in the form of better outcomes. Automation streamlines the operations of a medical facility, making them more effective and efficient. It is easier for different doctors and nurses to coordinate and diagnose a particular case. There are less chances of human error which ultimately leads to higher quality and safer care. With less time wasted in going through physical files and other manual work, doctors and nurses have more time on their hands to spend with patients.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
The picture of healthcare industry is changing rapidly and still continues to evolve, with technology playing a huge role and the other factor being the government. With a new administration in the White House, the Senate and the House of Representatives, there ought to be numerous changes in healthcare, modifying ACA being one of them. Come January, what will be the effect of the new policies of the GOP have on health IT?
In his victory speech, President-elect Donald Trump emphasized on restoring and improving infrastructure and calling healthcare and hospitals an integral part of that plan. The Trump administration even after a session is less likely to remove its focus from IT investments and developments in healthcare; the Republicans believe in leveraging technology and healthcare experts are confident that healthcare-related initiatives like Cancer Moonshot and Precision Medicine Initiative will continue to speed up.
According to a recent ONC report, 96 percent of hospitals and 78 percent of physician offices were using certified EHRs to maintain patient data.
With digital initiatives developing, the hassle in prescribing medicines, scheduling appointments and access to vital records have reduced.
Making the consumer the center of the healthcare system and empowering them has been favorable. According to a survey conducted on 13,000 users, it was revealed that 28% changed their providers based on data made available online – implying that patients wish to be a part of the decision making.
A substantial number of digital health startups have emerged, and their revenue in 2015 was over $4.5 billion – and continues to grow.
Health IT developments to look ahead
Although Donald Trump has his healthcare plan for the country under the covers, some significant advancements are coming our way and following is a slice of what’s coming:
Value-Based Care: One of the most important thing Trump has asserted on in his plan is that he wants to ensure that “no one slips through the cracks simply because they cannot afford insurance.” With U.S. healthcare accounting for 17.1% of the entire nation’s GDP, it’s important to back this transition towards value-based care.
Advancements in Interoperability: In ONC’s latest report to Congress, interoperability was tagged as an essential priority. There are still a lot of factors getting in the way of free flow of data between providers, topped with the inability on patients’ part to access their medical information freely. There are many initiatives on the block: the Sequoia Project’s Care Quality programs, the development of FHIR standards that will be backed by Trump and will pan out impressively.
Banking on Digitization: In sustaining the momentum of this transformation, digitization would be the cornerstone. The use of data analytics, machine learning, patient-centered technology developments and the Internet of Things will unleash their forces under Trump administration and fuel further developments and investments.
Changing the Dynamics of the Marketplace: Donald Trump plans to allow insurance companies to sell their plans across the state lines which may result in an increase in competition and making their plans value-focused. Allowing a free market for drug import could also prove critical in reducing the cost of healthcare: he said in one of his speeches that Medicare could save as much as $300 billion every year, if drug prices were negotiated.
Health IT will stay because the need is to continue to work on making healthcare industry interoperable. Major value-focused programs on healthcare by federal government, such as MACRA won’t see significant changes. However, there is a possibility that the Quality Payment Program could be “enhanced.”
Guest post by Richard Loomis, MD, chief medical officer and VP of informatics, Practice Fusion.
If you bill Medicare, changes are coming in 2017 that may affect your reimbursements. Existing programs such as the electronic health record (EHR) Incentive Program (meaningful use) and the Physician Quality Reporting System (PQRS) are being replaced by a new payment system called the Quality Payment Program (QPP), which is a complex, multi-track program that will adjust payments from -9 percent to +37 percent by 2022. The Centers for Medicare & Medicaid Services (CMS) recently released the final rule that will implement the QPP as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
While the 2,300-page final rule outlining the new program is complex, successful participation in 2017 doesn’t have to be. Here are some tips on how to participate in the QPP starting January 1, 2017 to minimize the risk of any negative adjustment to your Medicare Part B payments beginning in 2019.
Step 1: Check if you qualify to participate
CMS has expanded the range of clinicians able to participate in the QPP compared to Meaningful Use (MU). Eligible clinicians now include physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists. However, you’re excluded from participating in 2017 if:
You’re a clinician enrolling in Medicare for the first time. You’re exempt from reporting on measures and activities for the Merit-Based Incentive Payment System (MIPS) until the 2018 performance year.
Your practice meets the low-volume threshold. This means your Medicare Part B allowed charges ? $30,000 OR you see ? 100 patients covered by Medicare Part B during the 2017 calendar year.
Step 2: Choose your participation track
Although the QPP will begin January 1, 2017, there will be a ramp-up period with less financial risk for eligible clinicians in at least the first two years of the program. CMS designated 2017 as a transition year to help providers get started in either of the two participation tracks: MIPS or the Advanced Alternative Payment Models (Advanced APMs).
MIPS streamlines current Medicare value and quality program measures — PQRS, Value Modifier (VM) Program and MU — into a single MIPS composite performance score that will be used to adjust payments. All eligible clinicians who are not participating in an Advanced APM should report under MIPS in 2017. Conversely, you’re not required to participate in MIPS if you’re participating in an eligible Advanced APM, as described below. Some APMs, by virtue of their structure, are not considered Advanced APMs by CMS. If you participate in an APM that doesn’t qualify as an Advanced APM, it will increase your favorable scoring under the MIPS participation track.
APMs are new approaches to paying for medical care through Medicare that provide incentive payments to support high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. The main difference between the MIPS and Advanced APM programs are that Advanced APMs require practices to take on more financial and technological risks.
They receive a five percent lump sum bonus payments for the years 2019-2024.
They will receive a higher fee schedule update for 2026 and onward.
It’s important to note that if you stop participating in an Advanced APM during 2017, you should make sure you’ve seen enough patients or received enough payments through an Advanced APM to qualify for the five percent bonus. If you haven’t met these thresholds, you may need to participate in MIPS reporting to avoid a negative payment adjustment.
Guest post by John Barnett, project coordinator at Iflexion.
With evolving requirements for care value and quality, caregivers turn to technology to handle emerging challenges related to patients’ health outcomes, care costs and CMS reporting. Each year, new tech-driven solutions arise to assist providers in complying with changing circumstances.
The upcoming 2017 will be even more interesting technology-wise, since after Donald Trump was elected the new President, it’s now possible to form a very different perspective on healthcare. With this in mind, let’s look into market analysts’ predictions for growing trends to watch next year.
3D imaging, augmented and virtual reality
Currently, MRIs and CT scans allow viewing patients’ body parts, organs and tissues in 3D. 2017 may uplift care delivery by harnessing 3D imaging and improving it with augmented and virtual reality.
Caregivers can adopt 3D imaging for patient education and engagement, as well as for treating mental health disorders, such as phobias and schizophrenia.
Surgeons, physicians and nurses might use 3D and enabled glasses for further education and training – for example, to simulate complex microsurgeries. Augmented reality can be harnessed during live surgeries as well, allowing more precision to locate organs and blood vessels accurately, reducing possible damage to healthy tissue.
For instance, eye and brain surgeries imply working in limited spaces, using high-powered microscopes, and making cuts sometimes smaller than a millimeter (e.g., in retina surgery). 3D cameras can widen the picture and allow the whole team to see the target area. When 3D view is coupled with enabled glasses, this may also reduce surgeons’ fatigue from constantly looking into a microscope and keeping an uncomfortable posture with bowed heads and strained necks.
Artificial intelligence (AI)
While physicians have remarkable capabilities to analyze patients’ symptoms and make deductions, still humans can process quickly only a limited volume of information. This is where technology comes into play to support experience and proficiency.
Particularly, artificial intelligence software development is anticipated to become one of the widespread trends of 2017, with such headliners as IBM, Google, Amazon and many others.
AI encompassing machine learning and big data analytics evolves to make multiple healthcare processes faster and more effective. Some of the examples of future benefits are:
Automated diagnostics based on medical images
Predicted disease progression with chances to develop complications and further admissions / readmissions
Predicted reaction to chemotherapy in cancer patients
Calculated groups of at-risk patients (such as chronic patients with multiple conditions) according to their vitals, heredity, prior diseases, passed procedures and more to enroll them in specialized connected health programs
Predicted care results and patients’ health outcomes according to established treatment plans, allowing to intervene timely and improve care delivery
Many of future solutions will support natural language processing, as big data in healthcare usually comes in big chunks of unstructured information. If surgeons, physicians and nurses are able to input information directly with their voice, this will also reduce time, effort and, ultimately, costs.
In virtually every context that question might be asked, we struggle to give an honest, accurate answer.
It Works If You Believe It Works
Is the medication working? Difficult to say–it may be the placebo effect, it may be counteracted by other medications, or we may be monitoring the wrong indicators to recognize any effect. Is “working” the same as “having an effect,” or must it be the desired effect?
Alternative medicine confounds the balance of expectations and outcomes even further. Right at the intersection of evidenced-based medicine and naturopathy, for instance, we have hyperbaric oxygen therapy, or HBOT. These devices are as much in vogue among emergency departments (to treat embolisms, diabetic foot ulcers, and burns) as holistic dream salesmen (to prevent aging and cure autism, if you believe the hype). When the metric being tracked is as fluid as the visible effects of aging, answering whether the treatment is working is about as subjective as you can get.
As though the science of pharmaceuticals and clinical medicine weren’t confounding enough, you can hardly go anywhere in healthcare today without politics getting added to the mix. In the wake of Trump’s victory in the 2016 presidential election, you have observers and stakeholders asking of the Affordable Care Act (ACA): is it working?
There’s Something Happening Here
It is definitely doing something. It is measurably active in our tax policy, for instance: 2016 returns are heavily influenced by the incremental growth of the ACA’s financial provisions. Of course, the point of this tax policy (depending on who you ask) is to influence behavior. As to this point, there are some signs that, again, something is happening: among young people, ER visits in general are down, while emergency stays due to mental health illness are up. We changed how healthcare is insured, and that changed, in turn, how we access our care. But is it working?