People-Centered and Integrated Health Care
67th World Health Assembly
HHS Secretary Kathleen Sebelius
March 19, 2014
Thank you for the kind invitation to speak.
As the United States Secretary for Health and Human Services, I have had an amazing opportunity to witness up-close the passage and implementation of the Affordable Care Act, or “ACA.”
As you may have heard, it has done nothing short of revolutionize America’s health care structure.
Our previous system suffered from a number of ills—sky-rocketing costs, coverage that could be dropped when someone got sick, and many barriers to care, to name a few. But one of our biggest challenges was a basic disconnect within the field. For various reasons, our care focused on treating symptoms without thought to the wellness of a patient.
Thanks to the Affordable Care Act, key changes have been implemented to place the patient at the center of her care, and while problems still exist, we have made enormous progress.
ACA and Integrated Care
The Affordable Care Act’s commitment to integrated care is about treating the whole patient, not just the illness.
Imagine a patient is diagnosed with lung cancer. It’s stage 1 and still quite treatable. His oncologist sits down to explain his treatment options—but at no point does his doctor tell him to quit smoking.
Obviously, this would be nearly unthinkable, but with the compartmentalization of health care, something similar could happen for hypertension or diabetes
So what does the Affordable Care Act’s whole-patient approach mean in practice?
It prioritizes preventive care to circumvent problems before they begin. The law guarantees that, with insurance, Americans can get check-ups, screenings, and other preventive services at no cost.
The law recognizes that mental health is vital to physical health. By helping primary care doctors utilize behavioral health and substance abuse services, they can help patients better care for themselves. The Affordable Care Act uses care managers and behavioral health consultants to help doctors do just that.
And it connects teams to address a range of health needs. My Department supports a team-based model through Community Health Centers. Physicians, nurses, social works, health educators, and many others are encouraged to collaborate. And that includes empowering the patient to be a partner in that work.
Quality Over Quantity
Ultimately, we are shifting our focus from quantity of care to quality of care. Instead of paying for tests administered, we are incentivizing positive health outcomes. We are rewarding smarter care that keeps people out of the hospital—and from using the emergency room as primary care. And by creating Innovation Labs to test different arrangements, we hope to encourage more creative ways to address the needs of patients in the future.
Health care is at the heart of our mission at HHS, but my Department has always recognized the important link between health and the wellness of communities—or the “Human Services.” The Affordable Care Act works in conjunction with our other initiatives—early childhood education, efforts to reduce childhood obesity, protecting against elderly abuse and neglect, and the research and development of new medicines and medical technology.
The results of this kind of big-picture model are clear: lower costs and improved health.
In the Obama Administration, for example, we have seen first trimester prenatal care increase and the percent of low birth-weight babies decrease. We have also seen similar improvements in managing diabetes and hypertension.
When patients are placed at the center of their care, the entire system benefits. Doctors can make informed decisions, insurers avoid covering unnecessary treatments, and of course, individuals can better manage their own health. It’s a winning formula for everyone.