The document discusses the increasing role of the American patient in healthcare policymaking, particularly in managing chronic diseases and promoting preventive care. It highlights key healthcare initiatives, including the Affordable Care Act, meaningful use of electronic health records, and the establishment of Accountable Care Organizations to enhance patient-centered care. Furthermore, it outlines the fiscal implications of healthcare costs and demographics, emphasizing the importance of patient engagement and accountability in reducing healthcare expenditures.

2. Part One
the american patient
meaningful use
the affordable care act
accountable care organizations
patient-centered medical home

3. THE American Patient
More and more in policymaking, the U.S. government is seeking to actively
engage the American patient or their caregiver as a participant in the care
management process. With chronic disease impacting nearly 140 million
Americans today, it remains a critical factor to reining in health care spending.
Experts believe one of the principal causes of chronic disease is that the American
patient is unengaged and not held accountable for lifestyle choices made. The
provider community can expect this point to be pressed in future policymaking
and their ability to successfully deliver patient-centric care linked to
reimbursement in the near future.

4. THE American patient
309
Millions of people living in
51% Percent of the U.S.
population that is
male (49 percent) &
78.7
Life expectancy for all
the United States of America 49 % female (51 percent)
genders &
demographics in the
40.3
Millions of Americans ages 65+ (17.3 percent live in U.S., as compared to
Florida); this demographic is expected to grow to 88.5 83.9 in Japan & 49.4
million by 2050 in South Africa
1.4 Millions of men & women who serve as
active duty military in defense of America
35.7
Percent of American
14.1
Billions of dollars spent on
medical services directly
attributed to childhood
obesity alone adults who are obese

5. THE American patient
190
Thousands of 2012 expected cancer
7.1
Millions of Americans that are 20
deaths in the U.S. that are linked to estimated to have undiagnosed
obesity, physical inactivity & poor diabetes
nutrition - all of which is preventable
5.4
Percent of U.S. adults who meet the
573
criteria for substance dependence or
abuse
Millions of Americans of all ages that
Thousands of Americans who die will have Alzheimer’s in 2012, the
from heart disease, the leading cause sixth leading cause of death in the
of death in the U.S. U.S.
10
18.3
Millions of Americas that were
2.7
Trillions of dollars that was estimated
Percent of Americans ages 12+ who
are on antidepressant medication, the
physician-diagnosed with diabetes by as the U.S. national health third most commonly prescribed drug
2008 expenditure in 2011 in the U.S.

6. THE American Patient
31 356
Dollars per person that was spent on
75
Billions of dollars spent total on
health care in the U.S. in 1970 health care in the U.S. in 1970
Percent of U.S. health expenditures that are
attributed to hospital care
20
8,402
Dollars per person that is spent on
250
Billions of dollars that were spent on
health care in the U.S. today prescription drugs, representing 12
percent of personal health care
Percent of U.S. health expenditures that are expenditures in 2009
4,072
attributed to physician or other clinical
services
Dollars per person that is spent on
60 health care in the Germany today
Percent of adult Americans with private
health care coverage as of 2010

7. meaningful use
Enacted under the American Recovery and Reinvestment Act of 2009 (ARRA),
HITECH promotes adoption of interoperable electronic health records (EHRs) by
health care providers through financial incentives under the Medicare or Medicaid
EHR Incentive Programs, also known as “Meaningful Use.” This piece of
legislation is designed to reward and accelerate the adoption of interoperable,
certified electronic health records (CEHRT). Meaningful Use was launched on
Jan. 1, 2011, bringing the carrots of incentive dollars to many providers and
hospitals. The threat of sticks for non-adoption lurks as of 2015 through payment
adjustments in Medicare provider reimbursement.

8. meaningful use
3,662
Eligible hospitals that have registered 51.3
3.7
Billions of dollars that has been paid
for the CMS Medicare & Medicaid
to eligible hospitals for successful
EHR Incentive Program
attestation to Stage 1 Meaningful Use
Percent of all physicians in the U.S.
163,748 995
who report that they intend to pursue
the Meaningful Use incentives under
Medicare or Medicaid
Eligible professionals that have Millions of dollars that has been paid
registered for the CMS Medicare EHR to eligibile professionals for
Incentive Program successful attestation to Stage 1
57.6 Meaningful Use under Medicare
81,029
Eligible Professionals that have
Percent of physicians under age 45
who plan to apply for Meaningful Use, 11,588
as opposed to only 44 percent of Family practice physicians that have
registered for the CMS Medicaid EHR physicians ages 55+ successfully attested to Stage 1
Incentive Program
Meaningful Use under Medicare

9. meaningful use
10,597 215
30,204
Physicians that have attested to adopt,
Internal medicine physicians that have
successfully attested to Stage 1
Meaningful Use under Medicare
Eligible professionals that have
successfully attested to Stage 1
implement or upgrade (AIU) certified Meaningful Use under Medicaid
EHR technology under Medicaid
3,884 7,859
8,045
Mid-level eligible professionals who
Cardiologists that have successfully
attested to Stage 1 Meaningful Use
under Medicare
Hospitals & eligible professionals that
have attested under the CMS EHR
44
have attested to to year one AIU under Incentive Programs in Texas for a total
Medicaid; this includes Nurse of $483,550,804 in incentive payments
Practitioners (6,812), Mid-wives (886) (highest performing state)
& Physician Assistants (347)
101
States that have launced the Medicaid
EHR Incentive Program
2,237
Dentists that have attested to year one 852 Hospitals & eligible professionals that
have attested under the CMS EHR
Incentive Programs in North Dakota for
AIU under Medicaid Millions of dollars that have been paid to a total of $2,307,325 in incentive
eligible professions for successful Stage payments (lowest performing state)
1 Meaningful Use under Medicaid

10. THE AFFORDABLE CARE ACT
In March 2010, President Obama signed the most substantial bill transforming the delivery
of health care in the U.S. into law since creating Medicare and Medicaid – The Affordable
Care Act (ACA). On June 28, 2012, the Supreme Court of the United States (SCOTUS)
ruled that ACA, including its individual mandate that virtually every American must buy
health insurance, is constitutional. Under §3007 of ACA, the government will be using
quality and cost data to move from being a purchaser of health care services into a
purchaser of value. Beginning in 2015, HHS must establish a payment modifier for
value-based purchasing to physicians and physician groups. These differential payments
will be delivered by HHS under a fee schedule based on quality as compared to cost.
Quality will be based on a combination of measures such as outcomes, functional status,
shared decision-making, use of health IT, timeliness and patient experience (many of the
items required under NCQA’s patient-centered medical home model). Cost measures will
include such items as socioeconomic and demographic characteristics (e.g. race,
ethnicity, language, etc.) and patient health status. The big point to note is that matters of
establishing quality, costs and the value-based payment modifier are to be done totally by
HHS without being subject to administrative or judicial review.

11. THE AFFORDABLE CARE ACT
2,409
Number of pages contained in the 12 73
Number of times Accountable Care
Patient Protection & Affordable Care Number of times Payment Modifier is Organization is mentioned in ACA
Act of 2010
15
referenced as it relates to physician
55
reimbursement for Meicare Part B
Physician Fee Schedules
29
Number of times the Medical Home is
Number of pages contained in the mentioned in ACA
Health Care & Education
Reconciliation Act of 2010
Number of times Quality Reporting is
36
193
discussed as it relates to clinical data
Number of times
Number of pages in the Supreme
Court’s final opinion of the ACA 58 Patient-Centeredness is
referenced in ACA
8
Number of times Federally Qualified
Health Centers (27), Rural Health
Clinics (14) & Community Health
Centers (17) are referenced
84
Number of times Value-Based is
Number of pages contained in the mentioned as it relates to reforming
Constitution of the United States hospital & provider reimbursement

12. THE AFFORDABLE CARE ACT
Number of states
enjoining lawsuit against
the Medicaid Expansion
issue of the ACA
Number of Justices who
heard Oral Arguments on
ACA’s Individual Mandate &
Medicaid Expansion issues
Number of Justices
rendering the
majority favorable
decisions on the
Number of times the
constitutionality of
Supreme Court Opinion
the ACA
mentions broccoli

13. Accountable Care Organizations
Created under ACA, CMS began contracting with Accountable Care Organizations
(ACOs) to provide services for a defined population of Medicare patients with two
launch dates: April 1, 2012 and July 1, 2012. There are three ACO models: one
with no risk, one with risk and one deemed a “Pioneer” model. Each ACO will
need to be armed with technology tools such as EHR, HIE and Patient Portals as a
foundation for achieving cost-effective and patient-centric quality of care. The
rules governing assignment of Medicare beneficiaries, the 33 quality measures,
eligibility considerations for FQHCs and RHCs, NCQA’s ACO recognition program,
and the desired reformation being sought by CMS were released in final on Oct.
20, 2011. Since that date, not only has CMS has been moving forward with this
innovative care delivery model, but the private industry has also joined the mix.

14. Accountable Care Organizations
118
Hospital-sponsored
70
Physician-sponsored
29
Health Plan-sponsored
8
Community-Based
ACOs in 22 states ACOs in 23 states ACOs in 22 states Organization-sponsored
(99 in Oct. 2011) (38 in Oct. 2011) in 4 states
148 32
Pioneer ACOs contracted to the Centers for
Medicare and Medicaid Innovation (CMMI)
under the Affordable Care Act
Single Provider ACOs - meaning
27
typically an integrated delivery
system that receives risk-based Medicare Shared-Savings ACOs contracted
reimbursement from the payer to CMMI under the Affordable Care Act
5 Advanced Payment ACOs contracted to
CMMI under the Affordable Care Act

15. Accountable Care Organizations
221 45
Number of public Number of
25
& private ACOs in states with an
the U.S. ACO
States without an ACO: States with only one ACO: Alaska, Number of ACOs in
Delaware, Idaho, Rhode Arkansas, Hawaii, Kansas, Louisiana, California, the state
Island, South Dakota, Mississippi, Nevada, Oklahoma, South with the highest
West Virginia Carolina, Utah, Virginia, Wyoming number of ACOs
States advancing the Medicaid
ACO models: Colorado,
Minnesota, New Jersey,
Oregon, Utah

16. Patient-centered medical home
The patient-centered medical home (PCMH) is a care delivery model that partners
a primary care provider to other teammates for a coordinated effort at managing
patients, the goal being to deliver quality of care and value to the patient as a care
team. The returns on improved patient quality, improved patient health and
reduced costs of care are measurable. Because prevention, wellness and
long-term healing not only promotes quality of care but saves money, both public
and private payers are beginning to pay differentially to providers with PCMH
recognition. There are four organizations that offer PCMH accreditation,
certification, achievement or recognition, namely: The National Committee for
Quality Assurance (NCQA), The Joint Commission, URAC and the Accreditation
Association for Ambulatory Health Care.

17. Patient-centered medical home
75 4 Million 176
Organizations & locations that have
Of the 149 NCQA PCMH 2011 factors that Blue Cross Blue Shield members in 39
states across the country that are received Joint Commission accreditation
directly relate to improving patient & Primary Care Medical Home
engagement, population management & care benefiting from care delivered through
BCBS PCMH initiative certification
management for primary care providers
8 $2.26 41
States that have adopted policies &
Amount per patient increase in operating
Federal agencies are engaged in programs to advance medical homes
costs that is realized on average for
PCMH research, technical assistance,
8
delivering PCMH levels of care
demonstrations & funding projects,
including AHRQ, CMS, DOD, HRSA,
SMAHSA, NIH, NCI & VA
$18 States that are strengthening primary
24,020
care through ACA Section 2703 for
Amount per patient per month that is improved outcomes & lower costs
saved on average through the PCMH under Medicaid (AL, IA, KS, MD, MT,
from reduced emergency department NE, TX, VA)
Providers & clinic sites recognized for either visits & hospitilizations
the NCQA PPC PCMH or the NCQA PCMH
2011 programs in the U.S.

18. Patient-centered medical home
72
Percent of a given Millions of obese adults in the
population on average that U.S., representing one-third of
10 drives 60-70 percent of the
total health care costs for
the population; for U.S.
children, 17 percent are obese
that population
147
Billions of dollars spent in the
U.S. on overall medical care
costs due to obesity 44
Number of Type 2 diabetes
cases per 1,000 patients
443,000
Americans who die each
26
Millions of people
79
Millions of people
that can be delayed with
early intervention &
prediabetes screening over
a period of 3 years
year because of smoking
or exposure to
secondhand smoke
in the U.S. with in the U.S. with
48.3 5,455
diabetes pre-diabetes
174
Billions of dollars spent in the Dollars more that are spent per patient per
U.S. directly or indirectly on Percent of smokers who year to care for the health of a smoker as
costs related to diabetes quit in the past year after compared to a non-smoker
being advised to do so by
a physician

19. Stay Tuned for Part Two
electronic Health Record Adoption
& Health information Exchange
HIPAA privacy, Security & Breach Notification
Priority Primary Care Providers
Community Health Centers
B.R.I.E.F SURVEY RESULTS
CITATIONS