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 Center for Medicare and Medicaid Services (CMS) has announced 100 additional Accountable Care Organizations (ACOs) that will begin participating Continue reading
The Health Care Payment Learning Action Network‘s Alternative Payment Model Framework and Progress Monitoring Work Group has released its finalized Continue reading
The Centers for Medicare and Medicaid Innovation (CMMI) have announced the availability of funding for a new model for improving Continue reading
The Centers for Medicare and Medicaid (CMS) is requesting comment on its draft Quality Measurement Development Plan as part of Continue reading
This issue brief from the Center for Health Care Strategies describes the quality measurement approaches for accountable care organizations (ACOs) Continue reading
This issue brief from the Center for Health Care Strategies provides profiles of Medicaid programs in nine state (Colorado, Illinois, Iowa, Maine, Continue reading
This issue brief from The Commonwealth Fund and the Kaiser Family Foundation reports the results of a national survey of Continue reading
The Centers for Medicare and Medicaid Services (CMS) has issued this Request for Information about implementation requirements for the Medicare Continue reading
Ignatius Bau 