Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

When the Affordable Care Act was signed into law 3 years ago, many Americans paid attention to popular features like letting young adults stay on their parents' health insurance until age 26 or closing the "donut hole" gap for Medicare prescription drugs.

These portions of the health care law help a lot of people.

As of December 2011, 3.1 million more young adults had health insurance coverage as a direct result of the law, according to a national survey from the U.S. Department of Health and Human Services (HHS). Gains in coverage among young adults took place in every State. Big jumps (over 75,000 young people) were seen in California, Florida, Georgia, Illinois, Michigan, New Jersey, New York, and Texas.

And starting in 2011, the health care law gave an automatic 50 percent discount on brand-name drugs to Medicare patients who hit the "donut hole." The donut hole refers to a temporary coverage gap that happens once a patient's drug expenses hit a certain amount in a given year. (This year, for example, patients who enter the coverage gap pay nearly half for brand-name drugs and 79 percent for generic drugs until they get to the end of the coverage gap. At that point, a catastrophic coverage policy kicks in for the rest of the year.)

In 2011, the 50 percent brand-name drug discount helped patients get more than $2.1 billion in savings, or $604 per person, according to HHS. (The law changes the brand-name discount each year until the donut hole is closed in 2020). Some patients who had high drug expenses got rebate checks from HHS for $250.

Other parts of the health care law aren't as well-known, but they also are working to make sure your health care is high quality, safe, and affordable.

I'm particularly excited about one part of the law that is working to keep patients from returning to the hospital soon after they are discharged.

Each year, about 1 in 5 Medicare patients, or 2.6 million seniors, are readmitted within 30 days after they've been discharged from the hospital, a major study    found. Being readmitted to the hospital can slow down a patient's ability to recover or can cause new health problems. This is very expensive, costing the Medicare program about $17 billion per year and causing unneeded problems for patients and families.

Just as worrisome, many of these readmissions can be prevented. Often, patients recover when they understand how to take any new medicines they've been given and schedule follow-up appointments.

For example, patients might go their emergency room if they have a bad reaction to new drugs, if there was a miscommunication about medication, or if they could not get to a follow-up appointment with their primary care doctor. Patients need – but don't always get—follow-up care that's better coordinated across the entire care team, including physicians, nurses, pharmacists, physical therapists, and other health professionals.

The Affordable Care Act is working with hospitals with high readmission rates to improve. Hospitals with high readmissions for three conditions (heart attack, pneumonia, and heart failure) now get paid less than hospitals with fewer preventable readmissions.

And we're starting to see positive results  In 2012, the national rate of hospital readmissions for Medicare patients dropped to about 17.8 percent, compared with 19 percent for the past 5 years. This drop translates to more than 70,000 preventable readmissions each year.

In addition, the Agency for Healthcare Research and Quality (AHRQ) has funded the development of tools to help hospitals reduce preventable readmissions. The tools include a free brochure for patients and families called Taking Care of Myself: A Guide for When I Leave the Hospital that is available in English and Spanish by calling 1-800-358-9295.

Our ability to reduce hospital readmissions has never been higher, which is good news for patients.

In its 3-year history, the Affordable Care Act has made big strides in expanding coverage, reducing costs for patients, and improving safety and quality of care. While plenty of work remains, it's exciting to see how far we've come.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Navigating the Health Care System: Helping You Avoid Return Trips to the Hospital
http://www.ahrq.gov/news/columns/navigating-the-health-care-system/20120904.html

Re-Engineered Discharge (RED) Toolkit
http://www.ahrq.gov/professionals/systems/hospital/toolkit/index.html

Taking Care of Myself: A Guide for When I Leave the Hospital
http://www.ahrq.gov/patients-consumers/diagnosis-treatment/hospitals-clinics/goinghome/index.html

U.S. Department of Health and Human Services
Healthcare.gov
State-Level Estimates of Gains in Insurance Coverage Among Young Adults
http://www.healthcare.gov/news/factsheets/2012/06/young-adults06192012a.html

Healthcare.gov
Stronger Benefits for Seniors, Billions in Savings This Year
http://www.healthcare.gov/blog/2012/05/medicare052412.html

Centers for Medicare & Medicaid
Community-based Care Transitions Project
http://innovation.cms.gov/initiatives/CCTP/?itemID=CMS1239313

Health Affairs
The Affordable Care Act At Three: Paying for Quality Saves Health Care Dollars
http://healthaffairs.org/blog/2013/03/20/the-affordable-care-act-at-three-paying-for-quality-saves-health-care-dollars/   

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among Patients in the Medicare Fee-for-Service Program. N Engl J Med 2009; 360:1418-1428.

Current as of April 2013
Internet Citation: Health Law at Three Years Highlights Coverage, Cost, and Quality Improvements. April 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/040913.html