As Healthcare Evolves, We Must Address Challenges - and Preserve Our Progress



An important Open Enrollment deadline is quickly approaching. Tomorrow, December 15, is the last day to apply on HealthCare.gov for healthcare coverage beginning January 1, 2017.

Even as we prepare for the coming year, it is worth taking a look back at several significant events that occurred over the past few months. This fall, thousands of Tennesseans - including many of the people we serve - found themselves in a difficult situation when a major insurer decided to end individual marketplace plans in several cities, including Nashville. At the time, the other marketplace plans did not include Saint Thomas Health, which meant that when our patients switched to a different plan they would also have to switch to a different doctor. For a healthy person, choosing a new doctor can be frustrating. But for someone receiving care - the woman expecting her first child in January or the cancer patient who has three chemotherapy treatments left - it can be devastating.

For Saint Thomas Health, which is part of Ascension, the nation's largest non-profit healthcare system, the prospect of not being able to care for our current patients was unacceptable. We started negotiations with health insurance companies that still offered marketplace plans and quickly signed an agreement with Cigna. The agreement allows people who enrolled in a Cigna Connect plan to continue in-network care with Saint Thomas Health.

The Affordable Care Act, which passed in 2010, ushered in a new era of healthcare. Many of the changes that were part of this law were welcome. More than 20 million people gained access to healthcare. People with pre-existing conditions are no longer denied health insurance, and women aren't charged more simply because they are women.

We also started to see a broad industry shift as health systems, such as ours, worked to meet the demands of this new era and better serve our patients. Step by step, we have been moving toward a future in which patients' care is better coordinated from visit to visit; where greater efficiency leads to lower costs; and where doctors and hospitals are paid based on the value they provide, not the number of patients they see or procedures they perform.

While we've made good progress, there are challenges that still need to be addressed. Approximately 29 million people across the country still cannot afford healthcare, either because the policy premiums are too expensive in the first place or because they cannot shoulder their high co-pays and deductibles.

But there are also opportunities ahead. The strategic decisions that our health system, and many others, have made to better integrate care and begin the transition to value-based payments are the right ones. Now, we must roll up our sleeves and begin a meaningful conversation with our newly elected officials, business and community leaders, and even our friends and family about how we can address these challenges - while also preserving the progress we've made.

As part of Ascension, we are blessed to have a leading voice on the national stage as we advocate for our goal of 100 percent access and 100 percent coverage. We are in the middle of great change, and sometimes it is hard to see where the road may lead. But in the midst of this uncertainty, one thing is certain: All Americans and all Tennesseans deserve access to affordable healthcare.

It is imperative that we advocate for healthcare legislation that serves our communities, and this means being heard both in Tennessee and nationally. No matter how healthcare evolves, Saint Thomas Health and Ascension will continue to advocate for 100 percent access and 100 percent coverage. And until that happens, we will turn our words into actions by providing care to all persons with special attention to those living in poverty and the most vulnerable among us.


Karen Springer is president and CEO of Saint Thomas Health and senior vice president and the Tennessee ministry market executive for Ascension Health, the largest not-for-profit health system in the United States.