Health care reform is putting pressure on providers to decrease costs, increase quality and redesign the delivery of care, UC Health Senior Vice President John Stobo told UCOP employees at a Franklin building brown bag on Sept. 26.

President Barack Obama’s Affordable Care Act (ACA) is having a big impact on UC Health, California’s fourth-largest health care delivery system and the nation’s largest health sciences educational system. The November election will be an important milestone, but reform efforts will continue regardless of the outcome, Stobo said.

UC Health has recognized the need for reform. Four years ago, UC Health’s rates of central line–associated bloodstream infections were above the national average. Through a concerted effort, those rates are now below the national average.

“Seventy patient lives were saved by preventing these infections,” Stobo said. “This is one example of what we can do when we put our minds together as a system.” To continue the focus on improving quality, access and value, UC Health established the Center for Health Quality and Innovation two years ago. The center, which has hosted a colloquium and awarded a round of grants and fellowships, just issued a request for proposals for a second round of fellows.

The Affordable Care Act is a historic opportunity to improve the health status of the American people, UC Health Associate Vice President Cathryn Nation said. The law includes a number of provisions to help foster health professions training and workforce planning, although most have no funding appropriated. Meanwhile, some provisions also will heighten the nation’s existing health workforce challenges, which are particularly acute in California, where the population is increasing in size, age and diversity, she said.

“California has huge challenges because we are a large and complex state,” Nation said. UC Health has worked to close those workforce gaps, she said. Systemwide initiatives include:

• Increasing medical student enrollment through UC PRIME (approximately 300 more students training to serve medically underserved populations);
• Planning for a new school of medicine at UC Riverside (with a goal of admitting a first class in fall 2013); and
• Establishing new nursing programs at UC Davis and UC Irvine.

The goals for health care reform – from expanding coverage to controlling costs – remain similar to those of Republican plans dating back to President Richard Nixon, said Garen Corbett, director of the California Health Benefits Review Program. But now upwards of 50 million Americans have no health insurance, including 6.9 million Californians.

The Affordable Care Act aims to extend insurance to more than 30 million people, primarily through expanding Medicaid. Those with private health insurance already are benefiting from the law’s provisions for dependent coverage to age 26, no lifetime caps and no cost sharing for preventive services, Corbett said. For the uninsured, many key provisions are scheduled to take effect in 2014, such as Medicaid expansion, health insurance exchanges, premium subsidies and the individual mandate, which requires that most Americans obtain health insurance or face a tax penalty.

While the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act’s individual mandate in June, the law’s fate could turn on the November election, said UC Health and Clinical Affairs Director David Brown. If former Massachusetts Gov. Mitt Romney is elected president and Republicans gain control of the Senate, repeal of the ACA in its entirety or, at the very least, the individual mandate would be a real possibility, Brown said. If President Obama is re-elected, implementation of the law likely would stay the course.

Either way, the push to increase quality and decrease costs will persist, as will UC Health’s efforts to address those issues, Stobo said.

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