Among its many worthy goals, the Affordable Care Act (AKA Obamacare) aims to nudge the U.S. health care system from sick care to well care. By increasing the focus on routine checkups, preventive care, and better patient outcomes, Americans will be healthier. They will need less intensive, expensive health care. Health goes up, hospitalizations—and costs—go down.

In Philadelphia and its suburbs, hospital stays and days have dropped steadily—down about 12 percent*—since the enactment of the Affordable Care Act in March 2010. On the measure of less hospital care, could Obamacare be working?

As the leader of the region's hospital association, I can assure you that hospital leaders are indeed working to achieve the goals of the Affordable Care Act. They are rethinking how their organizations deliver health care. They are investing in new ways to keep patients healthier, to keep them out of the hospital. If hospitals were airlines, it would be like changing the wings on the airplane while in flight.

Is the drop in hospitalization the result of these efforts?

Like so much of health care, the answer is complicated. My organization, the Delaware Valley Healthcare Council of HAP, has been tracking declines in hospital use since before the Affordable Care Act. We found that as a result of the great recession of 2008–2009, many patients decided to postpone elective surgeries and other health care services.

What's more, our region's physician practices and hospitals have done their best to stay ahead of the curve. Efforts to reduce unnecessary hospitalizations by helping patients better manage chronic disease began years before the passage of the Affordable Care Act.

Regardless of the cause, the downward trend in hospital use is clear.

What's most remarkable to me is the way hospital leaders view this trend. They see less reliance on inpatient care as what needs to happen. They see investment in initiatives and services to improve the health of their community as what needs to be done.

Navigating big changes—changes that will challenge, stress, and even disrupt your organization or constituency for the good of the community at large—isn't that what leadership is all about?

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