Favorable prognosis: the health-care industry is making sweeping changes to control costs and bring better care to North Carolinians.

• Position: HEALTH CARE ROUND TABLE - Interview

Insurance reform, new technology and an emphasis on prevention are changing the health-care industry. How will they impact health care in North Carolina? How will they affect the Tar Heel economy? Will they alter how businesses are managed? BUSINESS NORTH CAROLINA recently gathered a panel of experts to discuss these and other questions. Participating were S. Lewis Ebert, president and CEO of Raleigh-based North Carolina Chamber; Karen Gledhill, shareholder and co-chair of Charlotte-based Robinson. Bradshaw & Hinson PA'S Health Care Practice Group; Dr. Steven Gold, primary-care physician at Hickory-based Frye Regional Medical Center and medical director of its wellness program; Stephen Keene, general counsel and deputy executive president of government affairs and health policy for Raleigh-based North Carolina Medical Society; and J. Brad Wilson, president and CEO of Chapel Hill-based Blue Cross Blue Shield of North Carolina Inc. The discussion was sponsored and hosted by Frye, with support from Charlotte-based Dixon Hughes Goodman LLP and Blue Cross. Peter Anderson, BNC special projects editor, moderated the discussion. The following transcript has been edited for brevity and clarity.

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What impact will the Patient Protection and Affordable Care Act have between now and next year, when it takes full effect?

Wilson: Health-care reform has been under way since March 23, 2010, when the federal Affordable Care Act became law. It has many components and fully blooms Jan. 1, 2014. But there's another important date--Oct. 1. That's when people without healthcare insurance will have access to federal and state online exchanges, where they can calculate the federal subsidy they will get, based on their income level, and purchase coverage. We're focused on that date, making sure the system supports the calculations, purchase decisions and enrollments during that 90-day window. One of the positives of the Affordable Care Act is that about 2 million more North Carolinians will be eligible for coverage after Jan. 1.

How can focusing on quality improve patient care and reduce costs?

Gledhill: Quality, not quantity, should be reimbursed. If you increase quality, you improve clinical outcomes and reduce costs. I see clients doing this daily. A hospital asked me to draft a contract with a medical-equipment provider. It covered providing home monitoring for patients discharged with a certain condition. That hospital is going to the expense--without reimbursement--of purchasing the equipment and training patients with the goal of reducing re-admissions, which cuts costs. The equipment allows patients to send clinical data, confirming their condition and that treatments, such as taking medications, are being followed. This way, changes in their conditions can be caught sooner and remedied outside the hospital.

Keene: What's occurring is a serious and productive transformation of how medicine is practiced. It was under way in the private sector before the Affordable Care Act became law. It's shifting health-care delivery from volume-driven compensation to value-driven compensation. That's good because it answers the question of how do we achieve quality, cost and access simultaneously. Ten years ago, I don't think we had a good answer. But what's been proven in the last three to four years is that by achieving goals based on the value provided by quality and access, you achieve cost containment. Accountable-care organizations are ones that agree to be transparent...