005: How the ACA and US History Shaped Healthcare – Patti Wahl

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How does our healthcare system work? Why does it cost so much? These questions are on everyones mind when we talk about healthcare, so in today’s episode I sit down with Patti Wahl who perfectly lays the groundwork for us to begin to uncover the answers to those questions!

Patti Wahl is the Senior Director of Value-Based Purchasing at the St. Louis Area Business Health Coalition where I work as well. Throughout Patti’s career she has worked on all sides of our healthcare system which has granted her a unique understanding of what goes on behind the scene when it comes to the American healthcare system.

Throughout the episode Patti brings many insights as We tackle questions about the history of our healthcare system that has propelled us to where we are today. Since Patti has accomplished the task of reading the entire Affordable Care Act we dig into how that affected the current state of our health system and where potential changes may push our healthcare system in the future.

Hope you enjoy the episode!

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Show Notes:

• Podcast Starts [01:15]

• Senior Director of Value-Based Purchasing at the St. Louis Area Business Health Coalition. Prior to that she worked for a large health system and did managed care negations. Prior to she worked at a regional health plan. [02:00]

• The three legs of the healthcare stool. [02:50]

• What has Patti learned about the cost of healthcare. [04:20]

• Almost 50 Years ago Medicare was introduced and that spurred the direction of our health system but there were two big flaws. 1) Fee for service. 2) Any type of medical necessity was not allowed to be interfered with by government or other insurers. [04:30]

• 50 Years later we are now moving towards Payed for Value or Payed for Performance model, which means we are paying for the quality of care provided not the amount of care provided. [05:40]

• How is healthcare set up with the different payers today. On one side you have Medicare and Medicaide, which is the government, and on the other side you have the private insurers which is dominated by the employers. [07:15]

• What did the Affordable Care Act do? Patti Actually read the whole thing. Amazing! [11:35]

• The goals of the ACA were to increase access, reduce costs, and improve quality. [12:25]

• Did the ACA succeed on those three goals? [14:40]

• We dive into what is different between a fee for service and a value based payment system. There is a continuum -> fee for service, paid for performance, patient centered medical homes, shared savings/risk arrangements, and ends with capitation. [21:15]

• We are moving to a model in our healthcare system where providers will get paid more by keeping patients out of the hospital. [29:45]

• Who is pushing the levers currently in where our healthcare system is going? [30:40]

• Where does Patti see our healthcare truly shifting in the future? [33:40]

• If you could change anything about the future of our healthcare what would it be and why? [38:35]

• Advice for the future professionals of our healthcare field. [40:55]

“One of the Challenges that providers are having is that they have to live in two different worlds or as I call it, two different canoes. One leg in each canoe where in one canoe they make money having less utilization and in other canoe that make money with less utilization.” [26:20]

St. Louis Area Business Health Coalition

Patti’s LinkedIn Profile


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