Experimenting with Payment Reform
One of the most interesting concepts which is being promoted in the national health care reform legislation are “accountable care organizations” (ACO) – new or existing health care organizations which would assume responsibility (“accountability”) for improving the health outcomes of a defined number of patients (at least 5,000) in a specific geographic area. The ACO would be required to engage a sufficient percentage of the local providers (hospitals, physicians, community health centers, etc.) so that it could establish appropriate goals for quality outcomes and then take the cost savings from that quality improvement (for example, reduced number of avoidable hospitalizations) and distribute those savings among all the providers.
What is somewhat surprising about the degree of support and interest in the concept is that this is still largely an idea based on cost analyses and savings projections from Medicare claims data, with little practical evidence that it actually works to sufficiently change the current cost and payment incentives in our health care system. Moreover, while not excluding the ability of a hospital/health system, independent practice association or health plan to be a local ACO, the model contemplates a new type of administrative organization solely focused on these issues of quality improvement and shared cost savings. Finally, there are many actuarial, measurement and legal issues to overcome to make this concept viable.
This report summarizes the work to date and identifies future opportunities for Oregon’s Coordinated Care Organizations (CCOs) to advance health Continue reading
The Health Care Payment Learning & Action Network (LAN) has issued a “refreshed” white paper updating its framework for Alternative Continue reading
Here is the proposed rule for the second payment year (2020) of the Quality Payment Program (QPP) established by the Continue reading
The Center for Medicare and Medicaid Innovation (Innovation Center) at the Centers for Medicare and Medicaid Services (CMS) has released Continue reading
The American Medical Association (AMA) has published an “Action Kit” summarizing the proposed rule implementing the Medicare Access and CHIP Reauthorization Continue reading
The Centers for Medicare and Medicaid Services (CMS) has made available two additional resources about its proposed rule implementing the Medicare Continue reading
Buried deep (on pages 501-502) in the 900+ page pre-publication version of the Centers for Medicare and Medicaid Services (CMS) Continue reading
The Centers for Medicare and Medicaid Services has published this useful summary of its proposed rule implementing the Medicare Access and Continue reading
Ignatius Bau 