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.
The Centers for Medicare and Medicaid Services (CMS) has published its much-anticipated proposed rule to implement the Medicare Access and Childrens’ Continue reading
This Health Affairs-Robert Wood Johnson Foundation policy brief describes the key issues for implementing the new Medicare physician payment system Continue reading
Covered California, the state health insurance marketplace, has adopted strengthened quality reporting and improvement requirements for qualified health plans (QHPs) Continue reading
The Center for Health Care Strategies has published this policy brief describing lessons learned from the development and implementation of Continue reading
The U.S. Department of Health and Human Services (HHS) has achieved its announced goal of moving at least 30 percent Continue reading
The Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP), as part of a broad collaborative of Continue reading
This issue brief from the Center for Health Care Strategies describes how accountable care organizations (ACOs) funded by state Medicaid Continue reading
The American Medical Association and Center for Healthcare Quality and Payment Reform have published this guide to physician-focused alternative payment Continue reading
Ignatius Bau 