With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:
Dr. Spencer Berthelsen is the former managing director of Kelsey-Seybold Clinic in Houston. He retired from the industry March 10, and focused on accountable healthcare in the marketplace in recent years.
Editor's note: This interview has been edited for length and clarity.
Trib+Health: You studied accountable healthcare and its effect within the Texas health industry. What exactly does the term mean?
Spencer Berthelsen: A group of physicians and healthcare providers came together for the purpose of raising the value of healthcare, so that the quality goes up, cost goes down and value is increased. They dedicate themselves to this prospect and also invest in information technology, programs, people and facilities that will achieve this goal.
They certainly embrace alternative payment mechanisms that properly orient the organization to increasing value, which is typically converting from a paper service system into one that pays for taking care of a population over a period of time, giving them good healthcare outcomes and a good patient appearance that people will find attractive.
Trib+Health: What’s the most interesting thing that has evolved under the Affordable Care Act?
Berthelsen: When the ACA was implemented, the concept of accountable care organizations with regard to Medicare started. Kelsey-Seybold actually embraced accountable care with Medicare because we had already established our own Medicare plan, a program that now has about 30,000 members.
The remarkable thing is that the concept of accountable care has actually extended well beyond Medicare and into all of healthcare. We are seeing accountable care organizations throughout the country, and certainly in our Houston area. All healthcare providers have an idea of developing accountable care organizations, or have already done so.
Trib+Health: Would repeal and replacement of the ACA come as a benefit or detriment to the health industry in Texas?
Berthelsen: We can think of what we have now with the ACA as version 1.0 in healthcare reform. It needs further adjustment, and it probably won't be until we get to version 3.0 that we will all pretty much like what we have. Even the Democrats and former President Obama would agree that there are things in the Affordable Care Act that need to be adjusted and improved upon.
On the other hand, Republicans are about repeal and replace. As they get closer to that task, I think they are going to see that what's needed is improvement of version 1.0. In fact, we are seeing a lot of commonality with what the replacement would look like.
President Trump [in his address to a joint session of Congress] even said we need to preserve the concept that if you have a pre-existing condition, you can still get affordable healthcare, and those that have insurance should still have access to insurance afterward, through basic tenets of the Affordable Care Act.
I think instead of reconstituting reform from scratch, we are going to have movement toward a version 2.0. Republicans can probably repeal on their own, but it will require Democratic support in order to make the positive changes. I think what we’re going to have is an improvement on the Affordable Care Act in the marketplace, and in the net we may have something that’s actually closer to the final version.
Trib+Health: What are some of the biggest challenges in the healthcare industry, and if an improvement takes place, will the challenges still be around?
Berthelsen: The basic challenge we’re experiencing, and what’s mostly focused on the marketplace, is the biggest part of the Affordable Care Act — the risk pool needs to be enhanced so that insurance companies will come back into the marketplace with more competition in all regions. There will need to be limitations on these special enrollment periods where people can come in and out of the marketplace as they want to for healthcare.
We need to bring in a healthier part of the population into the marketplace so that the risk pool will be more representative of the population rather than just the high-risk parts of the population. I think we are going to have that improvement in the risk pool, which will be necessary to stabilize the marketplace, and that will be good for all.