Risk shift

Guess what? Insurers are no longer on the hook for EVERYTHING that goes awry in the medical world! The law set out to make the other players — consumers, providers, Big Pharma and others engaged in the actual practice of medicine — responsible for their part in treatment, outcomes and cost. By pushing such concepts as pay for performance, shared savings, centers of excellence and standards for the cost of and outcome of specific regularly performed medical services, PPACA shifted the burden from insurers to the rest of the crowd.

It was good science and even better politics, since it was one of the facets of the law that got insurers, however grudgingly, on board. And most of them now love the direction this shift is taking.

Primary care reverse shift

PPACA envisioned a return to taking care of business, or as much as possible, within medical practices. Part of that shift was shifting more folks from the "no coverage" to the "coverage" category so they were getting "traditional" medical care rather than just ER and hospitalization care. The law also favors new payment/reimbursement models.

This placed a huge burden on primary care clinicians. More patients with an onslaught of new paperwork related to fulfilling obligations of PPACA has led to many an unhappy practitioner.

But it also revved up access to primary care in rural areas, shifting practitioners from urban to rural centers of care. The greater demands have spurred innovation in telehealth, with new products designed to connect patient to clinic coming onto the market almost daily. Overall, this shift will lead to a healthier population and a high-tech component to clinical services that has been woefully absent prior to the law.

New entrants

As reported, PwC says PPACA led directly to the founding of at least 90 companies that are still in business today. The shift to investments in telehealth and telecom exceeded $1 trillion over the last five years, as entrepreneurs and existing companies battled for turf in support services for clinicians and hospitals.

Says PwC: "Digital health venture funding hit a record-breaking high in 2014, surpassing the $4 billion mark. Technology is seen as critical to delivering on a key aspect of reform: high quality at low cost."

PwC also says this chaotic marketplace abounds in disruptive opportunities, citing a burgeoning wellness niche "with no signs of retreat." You'd almost thing the Business Roundtable might table its objections to the law.

Insurance shifts from wholesale to retail

When PPACA first threw the switch on its website, sparks flew and critics howled. Despite the embarrassing start, the flood of consumers who raced to their computers to get insurance coverage changed the insurance landscape forever.

Agents could no longer count on face-to-face meetings with prospective clients to sell health coverage. Nor could they depend on employers to bring them most of their business. The website now rules, and he, or she, who builds the better online mousetrap will prevail. It's meant more business for software developers charged with figuring out how consumers buy insurance coverage over the internet.

Meantime, scenting the opportunities ahead, consulting firms did a Dr. Frankenstein on the old idea of private exchanges. They revived the concept and, although adoption has been slow, it's been steady.

States' status increases

Another Republican-like feature of the law: It shifts responsibility, and power, from the feds to the states. Medicaid expansion, for instance — it's up to the states to decide if they'll do it or not. Public exchanges — you wanna do it, or you want us to do it for you?

The beauty of the system, from the feds' standpoint, is that each state becomes responsible for the outcome of its decision around these crucial matters. New reports are showing that states that haven't expanded Medicaid are probably harboring thousands of residents with diabetes that could be diagnosed and treated if they had access to the expanded Medicaid services.

And states that depend on the feds for their premium subsidies could lose them depending upon the outcome of a U.S. Supreme Court case — and then would incur the wrath of all those deprived of insurance because of the lost subsidy.

For more PPACA anniversary coverage, read:

• PPACA's 5 biggest moments

• 5 most lasting effects of PPACA

• PPACA launched at least 90 new businesses

• Employers cutting worker hours to avoid PPACA