Jeff Semenchuk is a Chicago-based CEO of Zest Health, a digital startup disrupting health insurance. Semenchuk is also the former Chief Innovation Officer at Hyatt.
As Washington machinates on the future of health care reform, following another defeat of a Senate Republican plan to repeal the Affordable Care Act (ACA), the best chance for certainty for employers and consumers may be from the private sector.
With accessibility and affordability hanging in the balance of legislative action, development of new products and services to help consumers make choices, monitor their health, and navigate health systems are more important than ever.
Chicago’s digital health community, coupled with leading academic institutions and health care organizations, makes our city fertile ground for digital health initiatives that put the consumer at the center of health care decisions. That’s good news for consumers here and across the country, who may be fearing what will happen to coverage and costs whether ACA remains in force or is eventually repealed and replaced by a Republican plan.
Since the unveiling of the Affordable Care Act (ACA) in 2010, inefficiencies in the system have made the $3 trillion health care market the next likely sector to be disrupted by digital startups. Many digital health players in Chicago took up the challenge with a variety of offerings. Among them are MATTER, a not-for-profit incubator for digital healthcare, medical devices, diagnostics, and biopharma; Outcome Health, which offers digital content for doctors’ offices; and Livongo Health, with its digital tools and monitoring for managing diseases such as diabetes.
For consumers and employers look for clarity, consumer-centric digital health provides important solutions for finding better ways to obtain and pay for health care, including new payment cards and accounts such as Healthcare Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), and lower interest medical loans. In addition, personalized health data could gain greater usage in enabling consumers to manage their health for a more personalized experience.
Big data, analytics, and cutting-edge technology hold significant potential for reducing cost and consumption in health care, as well as improving the health of individuals and populations. Across the U.S. health care system, personalized data initiatives and studies are underway. One example is using data analytics and machine learning to prevent hospitalizations among patients with chronic heart disease and diabetes, which could potentially save billions of dollars a year. Digital tools and mobile apps that provide instant access to data, services, and better ways to pay are what will ultimately make a difference to Americans and their health.
Such innovation will empower consumers who are too often insulated from much of the discussions in Washington, which tend to occur mostly behind closed doors. To many of us, this is anathema to the highly personal nature of health care.
Meanwhile, Republican lawmakers are regrouping after the latest failed attempt—the so-called “skinny” plan that did not include a replacement for ACA. Three Republican senators joined Democrats in opposing the measure. Among them was Sen. John McCain (R.-AZ), who called for the return to “the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people.”
If McCain’s statement is any indication, Republicans will try again to come up with a plan to repeal and replace ACA. What that will look like is uncertain, although changes in health care legislation will likely come down to coverage and cost. Most of this impact will be felt by small employers and individuals who faced coverage mandates under the ACA, which may no longer apply. This raises questions about the viability of health insurance exchanges, which have been a source of coverage for many consumers. For large employers, the repeal of ACA would likely mean removal of mandates on coverage. But given the time and expense that these corporations have invested in rolling out new plans, it’s hard to envision them making wholesale changes to the coverage they offer, at least in the short term.
Rather than look to Washington to clarify or simply the process, consumers should look to digital health innovations for the answers they seek around how to obtain care and control costs. Solutions from the private sector may very well be the best answers to navigating a complex and fragmented system; understanding coverage, cost, and deductibles; and helping consumers face ongoing challenges in managing their health and accessing care.