Taking Triple Aim on Health Care with Josh Schultz

Posted on August 12, 2013

ELGL Intro

We’ve seen the clever Cover Oregon commercials and heard the back-and-forth about “Obamacare” also known as the Affordable Care Act (ACA). For those of us in the public sector, we may think that we won’t be impacted because of the quality health insurance offered by our city, county, or state. While this may or may not be true, it is true that everyone will be impacted in some way whether its the impact of the ACA on our organization’s budget or whether it is job market which will now need qualified professionals capable of understanding and carrying out the Act.

With so much uncertainty around the ACA, we have enlisted Josh Schultz to write about the ACA and its potential impact on you and also how it might impact your career. Josh is an Oregonian who relocated to New York City to work at the Medicare Rights Center. Josh is well versed on the ACA and welcomes feedback on his posts and recommendations for his future posts.  Before we give Josh the pulpit, we provide you with what makes Josh qualified to write about this complex issue.



Josh Schultz

Current Position: Client Services Associate at Medicare Rights Center — New York, NY

Specialties: Patient advocacy, Medicare, Affordable Care Act, U.S. Congress

Prior Experience:  Owner, Advocate for Patients LLC and Intern United States Senate and United States House of Representatives

Education: Willamette University, Bachelor of Arts (B.A.), Politics, Senior Thesis: “Health Care Reform After Scott Brown: Speaker Nancy Pelosi’s Sixty-one Days” and The George Washington University, Department of Health Policy: “National Health Reform and the 111th Congress” Prof. Sara Rosenbaum

Connect: LinkedIn and Twitter

Background Check on Josh via Medicare Rights Center

downloadJosh Schultz is a Client Services Associate at the Medicare Rights Center. While he was earning his B.A. in Politics from Willamette University in Salem, Ore., Josh built a health insurance consumer advocacy business. In this capacity, he helped patients around the United States navigate the fragmented health care delivery and insurance system, access needed medical care, and get their insurance claims paid. Josh is passionate about health care policy, and he views patient advocacy work at the Medicare Rights Center as a critical component to informing policymakers and ensuring good health policy outcomes.

Part I: Oregon and New York, CCOs and ACOs, and my career in health care policy

86million_preventiveIn May 2009, I finished my second year of undergraduate work at Willamette University. I decided to take a break from Portland’s gloomy weather, enrolled in courses at the George Washington University and flew to Washington, D.C. That June and July, policy-makers got serious about drafting what became the Affordable Care Act (ACA), and I tracked daily developments in the U.S. House and Senate as a student in a seminar at the George Washington Public Health School. At 20 years old, I was easily the youngest person in a course comprised mostly of medical doctors and health policy professionals.

That September, back at Willamette, I formed a health insurance consumer advocacy business. Over the following three years, I helped clients around the United States with health insurance coverage appeals, and laid the groundwork for potential Employee Retirement Income Security Act (ERISA) claims against Oregon and New York insurers. My work grabbed the attention of a Portland litigator who bought me lunch at a restaurant in the Pearl District. Over small plates, he explained the arbitrary and capricious judicial standard of review for decisions under ERISA, as understood by the Ninth Circuit Court of Appeals.  Then, he pressed me to go to law school. In 2009 I decided that, with or without a J.D., I would make my career in health care policy.

I chose my career at a time when health care costs consume 18 percent of GDP, up 200% since 1980, and will continue to increase as more Americans rely on entitlements like Medicare for their health coverage.  We fund these entitlements in large part through transfers from general U.S. tax revenues, and pressure to reduce spending by public health insurance programs will continue to increase as more beneficiaries enroll. This, of course, means options (read: job opportunities) for people in my field.

ACA Created Job Opportunities

Is-Healthcare-Technology-Caught-In-The-Crosshairs-of-Triple-AimThe ACA, especially, gave me options. Health systems from Oregon to New York are using ACA funds to coordinate care and experiment with different versions of what former Medicare chief Don Berwick termed “triple aim.” Academics, policy wonks, business executives, and Governor John Kitzhaber have embraced triple aim’s goals: to increase access to care, improve care quality and patient outcomes, and decrease health care costs. The ACA funded development of Accountable Care Organizations (ACOs) around the United States, to coordinate care and produce cost savings when providing health care to Medicare beneficiaries. As an incentive to accomplish triple aim, ACO physicians, hospitals and insurers share in potential cost savings and agree to absorb potential losses to the federal Medicare program if the ACO loses money.

Around the time the ACA was passed, the Oregon Legislature authorized working groups to gather input from patients, providers, and other stakeholders on how Oregon could accomplish triple aim within its existing Medicaid and CHIP programs, which provide health insurance to families and children with limited incomes. The triple aim model Oregon adopted was superior in scope and more bullish in ambition than the federal ACO model. The Coordinated Care Organization (CCO) enacting legislation passed with bi-partisan majorities in the Oregon House and Senate. Before they could make changes to Oregon’s Medicaid programs, officials flew to Washington, D.C., and convinced the federal government to approve the CCO demonstration project. Oregon has a federal waiver to experiment with triple aim for every Medicaid and CHIP recipient in the state, from 2012 through mid-2017. If Oregon does not achieve a 2% reduction in the annual growth of per capita Medicaid spending, financial penalties will be imposed on key stakeholders.

download (1)Notwithstanding the work I did for my clients as a health insurance claims consultant, I chose to begin my post-college career in earnest at a health care advocacy non-profit in New York City. When I accepted my position in New York, I made a conscious choice to move away from the triple aim being applied in Oregon, and broaden my exposure to the health care system’s challenges. My job is to help beneficiaries enroll in and access their health care benefits, enabling them to understand the benefit options available to them, and to advise them on how to save money on their health care costs more generally. Saving money for beneficiaries and helping them understand their options is an important piece of the health reform puzzle.

It is notable that in its agreement with the federal government to implement the CCOs, Oregon placed saving money for the health care system as the first priority among its three triple aim goals. (Saving the health care system money is different from saving money for beneficiaries.  Consistent with the federal Medicaid statute, Oregon’s Medicaid and CHIP enrollees already pay at most a nominal co-payment when accessing covered health care.) Non-profit health systems in New York are deploying ACOs to save the Medicare program money.  But, the success or failure of Oregon’s CCOs will have a big impact on the viability of the ACO business model.

The Road Ahead

imagesEach place I stop on my career path, I know that I will meet new people, develop professional contacts, and make friends. With all the work underway in health care, the contacts I make today have the potential to determine my trajectory going forward. In May 2013, I spoke at length with a family member and his colleague about the choices each of them had made at different points in their respective careers. We discussed how one decision – to accept a particular job at a particular agency or with a particular employer – can determine how a career moves forward in the years or even decades to come. I haven’t had to make too many of those decisions yet, but I have made at least one.

Whether I can contribute to system reform and achieving triple aim for New Yorkers, or whether my most meaningful contributions to triple aim will take place in other locations and other positions, is yet to be determined. I do know this: focusing on being in the present and doing my best now to make a meaningful contribution to the team I am working with, is the best way to ensure that I do make a difference. By doing this, I can ensure my success today, and prepare for the challenges and opportunities ahead.

Josh Schultz was raised in Portland and has a B.A. in Politics from Willamette University.  The opinions expressed in this blog are his own; they don’t necessarily reflect the views of his employer, ELGL, or any other entity.  You can e-mail Josh at joshuaschultz@gmail.com.  He is on Twitter and LinkedIn.

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