Now that the Affordable Care Act (ACA) is mostly decided law, we are, as a society, and as individual communities, starting to look more into the future to see what will change in the coming years.  Some things will most certainly change (more coverage, additional complexity, more personal responsibility and awareness about costs related to care).  Other things might not change (how hard it is to be responsible for our individual health behavior, the difficulty of working with our health insurance, the good intentions of our physicians). And then there are the genuine unknowns, or at least the ‘hard to get our hands around’ sort of things.

2 of these unknowns stick out, because they are central to health care, and I care about both of them.

The first unknown, which is getting some press here and here, is about the number of physicians and most importantly their role in our care  in a post-ACA world. I first started hearing about this at a public health conference a few years ago, and I began to understand the macro level planning that it takes to address the sorts of changes that are going on in our health care system.  The unknown here is centered around the role of the physician, which has been shifting, and is going to shift even further as the ACA unfolds.  While in the past we have see docs multiply their income and reach through adding nurse practitioners and physician assistants, now we’re entering a new world where many acknowledge that the care we need – PREVENTION – is simply not what the existing system now delivers.  Which brings us to the second unknown….

How is prevention going to happen in a post-ACA world?  How will it be funded?  Will there be a redesign between resource allocation (what we spend our money on) and resource effectiveness (does that resource produce the result we intend?).  Right now, we spend the bulk of our health care resources on treating disease.  Most forward thinkers understand that all roads to cost reduction lead to lifestyle change.  How we get there, or can we get there is the major conversation that remains ‘hard to get at’, yet central to the ultimate objective….lower costs, healthier people.