Attending the Bloomberg 2014 State of Healthcare Summit in New York last Friday, I was struck by the general consensus among the panellists that despite all the doom and gloom we've heard recently about insurance death spirals and the calamitous launch of, the Affordable Care Act (ACA) is indeed here to stay. All indications from the government, academic, industry, payer, and provider representatives on hand were that we must now grapple with the question of how to move forward within the existing Obamacare framework. That isn't to say that the speakers didn't see a need for more work to be done. As CEO of New York-Presbyterian Hospital Steven Corwin colorfully put it, Obamacare today may turn out to be akin to version 1.0, like a cellphone in 1986.

One potential health system evolution that was a recurrent point of discussion at the Summit is the increasingly blurred lines between payers and providers. Like Accountable Care Organizations, this is not a new idea but one that is nevertheless gaining steam under the ACA. Integration is on the rise as payers and providers look to maximize their returns and access to patients in a leaner reimbursement environment where value and effectiveness are paramount. For example, panellists noted that providers are taking a greater interest in sharing risk, whether by contracting with payers or launching their own insurance plans. Interestingly, there was some dissent on the appropriateness of these types of arrangements from the provider side. While the historical record for integrated payer-providers is mixed, it remains to be seen how effective this model will be in a post-ACA environment.

The question of how to more broadly reduce costs and overutilization to respond to the new value-based health care landscape was also broached. Provider and insurer representatives gently sparred over this topic, with the former noting that narrower networks could hinder the overall treatment experience by limiting patient choice and the latter countering that it would be wrong to conflate narrower networks with poorer quality and emphasizing the importance of looking at just how meaningful patients choices really are. Nirav Shah, Health Commissioner for the State of New York, was able to link this back to the issue of the lack of transparency in health care pricing that made headlines last year, pointing to the sizable disparity in the cost of a hip implant procedure between New York's neighboring Bellevue and NYU hospitals. Ultimately, one thing all sides agreed on was that health IT and electronic medical records are crucial to more efficiently delivering care.

Perhaps the most interesting takeaway for the medtech industry was the positive assessments of the ACA's likely impact on manufacturers. David Howard of Emory University and the CMS Medicare Evidence Development and Coverage Advisory Committee noted his expectation that insurance exchange enrolment will increase as individuals begin to take more advantage of available subsidies. On a similar note, Michael Sparer, Chair of Health Policy and Management at Columbia University's School of Public Health, expressed confidence in the eventual adoption of the ACA's Medicaid expansion nationwide. As evidence, he pointed to the similarly gradual but ultimately successful path to adoption following the program's introduction in the 1960s and argued that the levels of federal funding being offered will simply prove too good to leave on the table. Bloomberg's Michael Manns added that the increase in coverage should more than compensate for pricing pressures on manufacturers resulting from the ACA.

All in all, the Summit was an interesting window in on the experiences of those closest to the action as Obamacare really gets underway.

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