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What's Next for You and Your Doctors Under the New Health Care Law?

Worried health care reform will cause you to wait for treatment? Don't be.

— Dan Saelinger/Clare Agency; Prop and Wardrobe Stylist: Laurie Rabb; Hair and Makeup: Patrycja for Halley Resources

3. More time with your pharmacist

Another big plus that health care reform delivers: to better monitor medications and their interactions (which sicken thousands every year), pharmacists will receive funding to help patients manage their medications. “Patients will be able to sit down with their pharmacist to see if there should be changes or reductions in their medication regimen,” explains Dennee Frey, Pharm.D., a pharmacist and medication-management consultant for Partners in Care Foundation in San Fernando, California.

Last December, Frey’s own mother experienced the miscommunication common in medication prescribing. After suffering a ministroke, her mother was released from the hospital with a list of medicines to take. “Two of the medications were wrong and had been discontinued by her other doctors,” explains Frey. “Luckily, my mother had me to ask the right questions. As pharmacists, we’ve been waiting and hoping for these changes.”

4. Closing the doughnut hole

One of the law’s biggest accomplishments for those on Medicare is its eventual closure of a huge loophole in prescription-drug coverage, known colloquially as the doughnut hole. In 2010, Medicare pays 75 percent of covered prescription-drug costs until the total drug costs (including the deductible and copays) reach $2,830. After that, patients fall into the doughnut hole—or coverage gap—and must pay the full cost of prescription drugs until their total out-of-pocket costs reach $4,550, when coverage kicks in again.

In the past, when internist Cohen’s Medicare patients fell into the doughnut hole, many stopped taking their medications because they couldn’t afford them anymore. To help them, she would prescribe a different medication or scrounge the shelves in her office for free samples. “But that was very disruptive to my patients,” she says. “The changes in the law are a big improvement.”

Under the law more than 3 million older adults who fall into the coverage gap will get a $250 rebate this year. The law provides for a 50 percent discount on brand-name drugs in 2011, and a smaller break on generics, until the doughnut hole is closed by 2020.

5. Better coordination of your health care

To improve efficiency and care coordination, the new law offers funding for such pilot programs as “accountable care” and “medical homes.” Under the medical-home model pioneered in Vermont, for instance, physicians are paid extra for coordinating care for their patients. They also receive bonuses if a patient’s health improves based on quality-of-care guidelines. The goal of the program is to help patients—especially those with chronic illnesses—stay healthy enough to avoid hospital stays and expensive treatments, saving money in the long run.

Similarly, Medicare-funded accountable-care organizations will be established over the next 18 months to ease transitions between hospital and home, and will influence how medical teams, as well as hospitals, operate. “Medicare will be making hospitals responsible for the costs of patient readmission,” says Albert Siu, M.D., chair of Geriatrics at New York City’s Mount Sinai School of Medicine, “so we’re making a variety of efforts to improve and coordinate patients’ care as they leave the hospital.” These include coaching patients and family members through the transition process and having a health professional act as a link between hospital and home.

6. Changes to Medicare and Medicare Advantage

Under the new law the roughly 34 million adults who receive traditional Medicare benefits will see their coverage enhanced, as they’ll be eligible for annual checkups and cancer screenings free of charge beginning in January 2011.

An additional 11.4 million Americans over 65 receive their Medicare-covered health care through private health insurance plans known as Medicare Advantage. Today the federal government pays private insurers to manage these programs—14 percent more per person than they pay for the traditional Medicare fee-for-service plans—and, in turn, insurers offer additional coverage such as prescription drugs and dental and vision care. The new health reform law will reduce—but not eliminate—the additional payments to Medicare Advantage plans. Consumers may see some benefits—such as free gym memberships and eyeglasses—adjusted, as the law cuts $136 billion from Advantage programs. Medicare Advantage plans cannot, however, by law, cut guaranteed Medicare benefits.

In sort, the new law should improve and ensure continuity of patient care. Reuben has studied the provisions of the bill and says, “There is nothing I’ve read in the law that will adversely affect my patients. Nothing.”

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