Americans should not be deterred from working to improve our health care system despite difficulties with implementing the websites of the health insurance exchanges as part of the Affordable Care Act (ACA). Our resolve for improved health care should be stronger than ever. The U.S. has the best doctors and nurses in the world, and they work very hard, but they work every day in a broken system.

We spend 40 percent more per capita on care than other countries, yet we do not provide coverage for all of our citizens. Our citizens rate our system lower than the people of other nations do, and now many of our outcomes are not as good as those in other developed countries that spend far less.

For these reasons, former Massachusetts Gov. Mitt Romney worked to reform care in his state; subsequently, Mr. Romney's work in Massachusetts created the blueprint for President Barack Obama to create the ACA. The ACA is imperfect and too complicated, but it is an excellent step forward. The ACA has led to millions of Americans now having health insurance, and it has helped to foster "value-based purchasing" — until now, most individuals and employers purchasing care had no idea what they were paying for individual services or whether the services were actually creating more health. With the ACA, the nation is beginning to move toward greater transparency and the incentivizing of care delivery systems that reduce wasteful expenditures while improving the health and satisfaction of our people.

GBMC HealthCare is participating in a number of programs that began as part of the ACA. In one, the Medicare Shared Savings Program, we have saved Medicare roughly 2 percent of total expenditures in our first year while also extending hours of operation of our primary care offices, reducing needless emergency department visits and working to improve more than 30 metrics of patient outcomes and process measures of care.

Anyone who has run a large company knows that things do not always go as planned. The implementation of Maryland's health insurance exchange website had significant problems, but outside observers must understand that it was an incredibly complex task. The website uses software that must pull information from a number of databases and then run a complex algorithm to determine eligibility for subsidies. Our state, like all others, did not have the capability to create and implement such a system on our own, so we relied too heavily on contractors to do it for us.

Maryland, like Minnesota, chose an off-the-shelf software system and experienced many problems. The vendor Deloitte built four state exchanges (Connecticut, Washington, Rhode Island and Kentucky) by essentially writing a new software program and experienced a much more successful launch. Maryland is now engaging Deloitte to implement the software platform that has been successful in Connecticut.

It should also be recognized that Maryland's leaders took action and achieved their overall enrollment numbers despite the poor website performance. They significantly increased the number of staff members working to enroll people on the phone, and they worked closely with insurers in Maryland.

The idea of a health insurance exchange is credited to Governor Romney. He understood that there was no real market for small businesses in Massachusetts to purchase health insurance. Costs continued to skyrocket and businesses were having a difficult time. The exchange in Massachusetts successfully created more options for business owners. The new options included narrow network offerings where only high-value providers participated thereby maintaining or improving clinical quality and service while lowering costs. We must move quickly to implement a new exchange program to achieve the same for businesses and individuals in Maryland.

Now is not the time to look backward — the stakes are too high for our region and our country. We must stay focused on the national triple aim: better health, better care and lower cost. Let's stay in action to continue improving our health care system in Maryland and in our nation.

Dr. John B. Chessare is the president and CEO of GBMC HealthCare, Inc. He can be reached at jchessare@gbmc.org.


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