Category Archives: Health Care Reform: Accountable Care Organizations

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.

Oregon Health Authority Transformation Center: Opportunities for Oregon’s Coordinated Care Organizations to Advance Health Equity

This report summarizes the work to date and identifies future opportunities for Oregon’s Coordinated Care Organizations (CCOs) to advance health equity as part of their health system transformation activities. CCOs are obligated to identify and pursue opportunities to advance health … Continue reading

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Health Care Payment Learning & Action Network: “Refreshed” Alternative Payment Model Framework

The Health Care Payment Learning & Action Network (LAN) has issued a “refreshed” white paper updating its framework for Alternative Payment Models (APMs). The updates bring the framework into alignment with the APMs recognized by the Centers for Medicare and … Continue reading

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Centers for Medicare and Medicaid Services: Proposed Rule for MACRA Quality Payment Program Year 2

Here is the proposed rule for the second payment year (2020) of the Quality Payment Program (QPP) established by the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) .  Since there is a two-year lag between the performance … Continue reading

Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement, Health Information Technology | Leave a comment

Center for Medicare and Medicaid Innovation: 2016 Report to Congress

The Center for Medicare and Medicaid Innovation (Innovation Center) at the Centers for Medicare and Medicaid Services (CMS) has released its third report to Congress.  The Innovation Center was created by section 3021 of the Affordable Care Act. Under the ACA, … Continue reading

Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement | Leave a comment

American Medical Association: Action Kit on MACRA Proposed Rule

The American Medical Association (AMA) has published an “Action Kit” summarizing the proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA) and highlighting its preliminary comments and recommendations for changes to the proposed rule. Among the issues that the … Continue reading

Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement, Health Information Technology, Health Information Technology: Meaningful Use | Leave a comment

Centers for Medicare and Medicaid Services: Additional Resources on MACRA Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has made available two additional resources about its proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA).  The first resource is a set of slides describing the proposed rule. Link to Original … Continue reading

Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement, Health Information Technology, Health Information Technology: Meaningful Use | Leave a comment

Centers for Medicare and Medicaid Services: List of Alternative Payment Models (APMs) under MACRA Proposed Rule

Buried deep (on pages 501-502) in the 900+ page pre-publication version of the Centers for Medicare and Medicaid Services (CMS) proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA) is Table 32, which lists current Alternative Payment Models (APMs) … Continue reading

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Centers for Medicare and Medicaid Services: Fact Sheet on MACRA Proposed Regulations

The Centers for Medicare and Medicaid Services has published this useful summary of its proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA): Link to Original Source

Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement, Health Information Technology, Health Information Technology: Meaningful Use | Leave a comment

Centers for Medicare and Medicaid Services: Proposed Rule to Implement Medicare Access and CHIP Reauthorization Act (MACRA)

The Centers for Medicare and Medicaid Services (CMS) has published its much-anticipated proposed rule to implement the Medicare Access and Childrens’ Health Insurance Program (CHIP) Reauthorization Act (MACRA), which replaces the Sustainable Growth Rate formula for how fee-for-service or traditional Medicare … Continue reading

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RWJF-Health Affairs Policy Brief: Medicare’s New Physician Payment System

This Health Affairs-Robert Wood Johnson Foundation policy brief describes the key issues  for implementing the new Medicare physician payment system under the 2015 Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA). In 2014, Medicare paid physicians and … Continue reading

Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement | Leave a comment