Gilfillan to unpack reform’s effects on health insurance, delivery systems



Not in his wildest dreams did Richard Gilfillan hope to see the likes of the Affordable Care Act. By addressing issues in the health care insurance marketplace as well as in delivery systems, the Affordable Care Act exceeded the expectations of Gilfillan and many other health care professionals.

In fact, Gilfillan left his position as head of the Center for Medicare & Medicaid Innovation, where he worked for three years, this past June, citing a curiosity to explore the multitude of opportunities produced by the Affordable Care Act.

As part of Week Nine’s morning lecture platform on “Health Care: Reform and Innovation,” Gilfillan will speak at 10:45 a.m. today in the Amphitheater. Though he will explore health care reform in a general sense, he will specifically address reform in delivery systems and the process of improving the quality and efficiency of care.

While working at the Center for Medicare & Medicaid Innovation, Gilfillan steered the organization’s development of alternative payment and delivery models. Previously, Gilfillan worked as president and CEO of the Geisinger Health System in Danville, Pa.

“I am very excited about the momentum that has been created in the delivery system at this point,” Gilfillan said. “There is clearly massive engagement with lots of new ways of delivering care and paying for care.”

The Center for Medicare & Medicaid Innovation has seen to the development of more than 250 Pioneer Accountable Care Organizations (ACO) in multiple Medicare programs. ACOs provide incentives for hospitals and medical groups to help improve access and quality of care for patients.

“It’s incredibly exciting to think that [the government is] going to be providing health insurance to many of the people who have just never had it before,” Gilfillan said. “Forty-eight million uninsured people out there who don’t have coverage either through Medicaid expansion or through exchange plans — folks are going to have access to it.”

Gilfillan gave the examples of college students, who previously wouldn’t have been able to remain on their parents’ health insurance, and those with chronic medical conditions, who might not receive coverage if they lost their jobs. The Affordable Care Act has also enabled those with entrepreneurial spirits to pursue business ventures, when they might have otherwise been deterred by the fear of losing their health insurance.

“If we’re going to expand care, we really need to make it more affordable for people,” he said. “There are a lot of very real and concrete improvements that are happening that I think have direct impact on people’s lives.”

Gilfillan suggested that the positives of the Affordable Care Act outweigh the negatives.

“I think anything with this many positives and ramifications is going to have shortcomings that we eventually find that we’d like to be able to fix,” he said. “We are making progress, and there are occasional things that get delayed, but in the context of the massive improvements that are occurring, I think the things that are being delayed are not really consequential right now.”