Health Care Quality and Delivery System Reform
The Center for Medicare and Medicaid Innovation: A Year’s Progress
Posted on January 26, 2012
Improving the quality of care delivery and reducing explosive growth in healthcare costs is a cornerstone of The Patient Protection and Affordable Care Act (ACA). It reflects the shared understanding that the current silo-based approaches to care delivery that focus on settings of care (e.g., physician office, hospital) rather than care delivery across multiple providers and setting (e.g., episodic) are not working. Costs are increasing at an unsustainable pace, and evidence from leading researchers collectively points to serious deficiencies in health care quality and the disconnect between high spending and health care quality.
To foster the development of more collaborative and…
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Independent Payment Advisory Board (IPAB)
Posted on January 13, 2012
Section 3403 of the Affordable Care Act (ACA) established the Independent Payment Advisory Board (IPAB), a 15-member panel of appointed experts that will recommend cost-saving measures for Medicare. In the face of controversy about its structure and powers, legislation has been introduced in the 112th Congress to repeal its establishment.
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RWJF releases summary documenting that public health interventions lead to health care cost savings
Posted on November 16, 2011
The Affordable Care Act (ACA) created the Prevention and Public Health Fund, a 10-year, $15 billion commitment to support programs, medical screenings, and research related to public health and prevention. This national commitment to investment in preventing disease before it occurs is in line with evidence from a variety of recent reports and studies indicating that strategic investments in proven, community-based prevention programs could result in significant U.S. health care cost savings and overall economic cost savings. The Robert Wood Johnson Brief, “Return Investments in Public Health: A Summary of Groundbreaking Research Studies,” summarizes the findings and recommendations from four major studies released between 2008 and 2011.
GAO recommends automatic increases in FMAP
Posted on November 10, 2011
A recent Government Accountability Office (GAO) report introduces a prototype formula to provide states with temporary Medicaid assistance during national economic downturn. Once a threshold number of states–26 in the GAO formula–demonstrate a sustained decrease in their employment-to-population ratio, temporary increases to the Federal Medical Assistance Percentage (FMAP) will be automatically triggered under the GAO plan. This assistance will end when fewer than the threshold number of states show a decline in the ratio. Targeted state assistance would be calculated based on 1) increases in unemployment, as a proxy for changes in Medicaid enrollment; and 2) reductions in total wages and salaries, as a proxy for changes in states’ revenues. Such assistance would facilitate state budget planning, provide states with greater fiscal stability, and better align federal assistance with the magnitude of the economic downturn’s effect on individual states.
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International survey finds patients with complex needs often receive poorly coordinated care
Posted on November 9, 2011
A Commonwealth Fund international survey of adults living with complex care needs found that patients in the United States are much more likely than those in 10 other high-income countries to forgo needed care because of costs and to struggle with medical risk. In all of the countries surveyed, patients who have a medical home reported better coordination of care, fewer medical errors, and greater satisfaction as compared to those patients without one.
Health Affairs article evaluates bundled payment pilot project
Posted on November 8, 2011
The Affordable Care Act (ACA) introduced bundled payments, which provides payment for all of the care a patient needs over the course of a defined clinical episode. The goal of bundling payment is to encourage doctors, hospitals, and other health care providers to work together to better coordinate care for patients both when they are in the hospital and after they are discharged. An article recently released by Health Affairs evaluates the initial “road test” of the PROMETHEUS Payment, one of the bundled payment pilot projects. The pilots have taken longer to set up than expected, primarily due to the intricate payment model and the fact that it builds on the existing fee-for-service payment system. Although participants were hopeful regarding the success of the bundled payment program, the report found that desired benefits may take some time to materialize.
To read CMS’s Fact Sheet regarding Bundled Payments, click here.
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Update: Medicare Shared Savings Program for Accountable Care Organizations
Posted on November 8, 2011
While a primary aim of the Affordable Care Act (ACA) was to increase access to affordable health insurance coverage, a critical, although less publicized, component of the law is a series of provisions designed to improve health care quality and efficiency and to advance the concept of “value-based purchasing.” The Agency for Health Care Research and Quality (AHRQ) defines the concept of value-based purchasing as holding “providers of health care accountable for both the cost and quality of care.” AHRQ notes that “value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved.”
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Hospital Readmissions Reduction Program
Posted on November 1, 2011
Hospitals in the United States readmit an average of 20% of Medicare patients within thirty days of their initial discharge. These readmissions cost the Medicare program an estimated 12 billion dollars each year and may be an indicator of poor quality of care where the readmission was potentially preventable. In its June 2007 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) classified many hospital readmissions as potentially preventable. Based on these recommendations, Congress included the Hospital Readmissions Reduction Program (HRRP or Program) in the Affordable Care Act. CMS issued the final rule implementing the HRRP on August 18, 2011, although CMS will continue to clarify additional details of the program through future rulemaking.
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Urban Institute paper reviews status of ACO implementation
Posted on November 1, 2011
“Accountable Care Organizations in Medicare and the Private Sector,” a policy paper written by the Urban Institute and funded by the Robert Wood Johnson Foundation, examines the latest developments in accountable care organizations (ACOs), including a look at the final regulations issued last month by the Centers for Medicare & Medicaid Services (CMS). The paper provides an overview of ACOs, the key complaints about CMS’ proposed regulations and their resolutions in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans.
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HHS releases final standards to measure health care disparities
Posted on October 31, 2011
On October 31st, The U.S. Department of Health and Human Services (HHS) released final standards to measure health care disparities based on race, ethnicity, sex, primary language, and disability status, as required by the Affordable Care Act (ACA). Making these data standards consistent will help identify significant health disparities that often exist between and within ethnic groups. For example, a study showed that the diabetes-related mortality rate for Mexican Americans (251 deaths per 100,000) and Puerto Ricans (204 deaths per 100,000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100,000). However, these data would have remained unexamined had only the umbrella terms of “Hispanic” or “Latino” been used. By adding different ethnic origins as explicit categories on all HHS-sponsored health surveys, the government hopes to better capture and track the health differences and thus target interventions more appropriately.
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- Constitutional Challenges Update: Florida et al. v United States Department of Health and Human Services posted on January 4, 2012
- The Center for Medicare and Medicaid Innovation: A Year’s Progress posted on January 26, 2012
- Chronic Disease Management posted on February 23, 2011
- Hospital Readmissions Reduction Program posted on November 1, 2011
- Update to Consumer Operated and Oriented Plan (CO-OP) Program: Final Rule posted on January 18, 2012
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