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.

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

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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

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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

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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

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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

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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

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Covered California: Quality Improvement Requirements for Qualified Health Plans for 2017-2019

Covered California, the state health insurance marketplace, has adopted strengthened quality reporting and improvement requirements for qualified health plans (QHPs) seeking to sell health insurance through the California marketplace for 2017 through 2019.   The contractual requirements include: QHPs will ensure all … Continue reading

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Center for Health Care Strategies: Program Design Considerations for Medicaid ACOs

The Center for Health Care Strategies has published this policy brief describing lessons learned from the development and implementation of accountable care organization (ACO) models in state Medicaid programs.  Over the past four years, eight states (Colorado, Illinois, Maine, Minnesota, New Jersey, Oregon, Utah, and Vermont) have launched … Continue reading

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