This document discusses accountable care organizations (ACOs) as established under the Affordable Care Act. It provides background on the development of the ACO concept and its inclusion in the ACA. Key points include:
1) ACOs were created to improve quality of care, improve population health, and reduce costs. They allow groups of providers to be jointly accountable for the care of patients.
2) The ACA established the Medicare Shared Savings Program which created ACOs to coordinate care for Medicare patients. Over 360 ACOs now serve over 5.6 million Americans.
3) ACOs come in various forms but generally aim to better integrate care, increase prevention/chronic care,
The document discusses pay for performance (P4P) incentives in healthcare and their impact on quality, cost, and financing. It provides background on quality improvement efforts and defines key concepts like structure, process, and outcomes. It then outlines current legislation and initiatives like the Affordable Care Act that link reimbursement to quality metrics. P4P aims to change how care is delivered and financed to improve outcomes while reducing waste. However, it also impacts providers' finances as payments may decrease for preventable readmissions or hospital-acquired conditions.
The document summarizes key aspects of Ohio's executive budget and Medicaid reform plan, which aims to address an $8 billion budget deficit. Some key points include: reducing funding to local governments and schools by over $2.2 billion, agency reductions of over $2.3 billion, and Medicaid savings of $4.3 billion through reforms to payment rates, eligibility, and care coordination programs. The reforms restructure Ohio's Medicaid program and shift its focus toward home and community-based care through initiatives like Accountable Care Organizations and integrated care delivery systems.
This document provides an overview of the Patient Protection and Affordable Care Act (PPACA). It discusses the long history of healthcare reform efforts in the United States stretching back over a century. It also outlines the major components and provisions of the PPACA, including the creation of health insurance exchanges, expanded Medicaid eligibility, subsidies for individuals and businesses, and improvements to the quality and performance of the healthcare system. The PPACA builds upon but also differs from healthcare reform proposals put forth by previous administrations such as President Clinton's 1993 plan, which included a more regulatory approach with greater government involvement in the industry.
The document discusses how the Affordable Care Act aims to address problems in the US healthcare system like the large number of uninsured, rising costs, and quality and access issues. It will expand coverage to 32 million uninsured through Medicaid expansion and health insurance exchanges. Reforms to payment and delivery systems are also expected to help slow premium growth and reduce costs over time. Implementation will occur gradually through 2019, with many provisions taking effect in 2014 such as the individual mandate, Medicaid expansion, and state-based insurance exchanges.
The document discusses preventive and case-managed services offered by Nevada Medicaid. It describes how the Affordable Care Act expanded Medicaid coverage in Nevada, increasing the patient population for providers. The two main Medicaid managed care organizations (MCOs) in Nevada, Amerigroup and Health Plan of Nevada, are described as well as some of the preventive services they offer. The document recommends that the MCOs use Medicaid electronic health record incentive programs and encounter data to better monitor screening rates and identify gaps in care for populations. Using this data could help the MCOs improve outreach and preventive service delivery.
This document summarizes research on the impacts of consolidating local health departments (LHDs). It finds that consolidation can yield cost savings through economies of scale and more efficient service provision. Studies of Ohio LHD consolidations found reduced post-consolidation expenditures and up to $1.5 million in annual savings in one case. Consolidation may also improve public health services by enabling LHDs to better perform essential functions. However, the transition process can be disruptive to LHD operations in the short-term. Overall benefits and costs are specific to each situation, requiring local assessments.
Implementing Exchanges that Enhance Choice, Affordability, and Coverage hmartin920
The document discusses the establishment of state-based health insurance exchanges under the Affordable Care Act beginning in 2014. The goal is to expand coverage, slow cost growth, and provide subsidies. Prior state-run insurance cooperatives and purchasing pools had mixed results. Implementing exchanges will be challenging given each state's political environment and the economy. Stakeholders must work together to address complexities of reform.
- Healthcare costs in the US have rapidly increased since the mid-20th century, with spending reaching $2.8 trillion in 2012. Despite high costs, the US healthcare system ranks poorly on outcomes.
- Oregon implemented Coordinated Care Organizations (CCOs) in 2012 to contain Medicaid costs and improve outcomes. CCOs receive a fixed global budget to provide coordinated care through integrated networks.
- Early results show CCOs have decreased emergency room visits and hospitalizations while increasing primary care spending. This shift to preventative care is expected to further reduce costs and improve patient health over time.
The document discusses pay for performance (P4P) incentives in healthcare and their impact on quality, cost, and financing. It provides background on quality improvement efforts and defines key concepts like structure, process, and outcomes. It then outlines current legislation and initiatives like the Affordable Care Act that link reimbursement to quality metrics. P4P aims to change how care is delivered and financed to improve outcomes while reducing waste. However, it also impacts providers' finances as payments may decrease for preventable readmissions or hospital-acquired conditions.
The document summarizes key aspects of Ohio's executive budget and Medicaid reform plan, which aims to address an $8 billion budget deficit. Some key points include: reducing funding to local governments and schools by over $2.2 billion, agency reductions of over $2.3 billion, and Medicaid savings of $4.3 billion through reforms to payment rates, eligibility, and care coordination programs. The reforms restructure Ohio's Medicaid program and shift its focus toward home and community-based care through initiatives like Accountable Care Organizations and integrated care delivery systems.
This document provides an overview of the Patient Protection and Affordable Care Act (PPACA). It discusses the long history of healthcare reform efforts in the United States stretching back over a century. It also outlines the major components and provisions of the PPACA, including the creation of health insurance exchanges, expanded Medicaid eligibility, subsidies for individuals and businesses, and improvements to the quality and performance of the healthcare system. The PPACA builds upon but also differs from healthcare reform proposals put forth by previous administrations such as President Clinton's 1993 plan, which included a more regulatory approach with greater government involvement in the industry.
The document discusses how the Affordable Care Act aims to address problems in the US healthcare system like the large number of uninsured, rising costs, and quality and access issues. It will expand coverage to 32 million uninsured through Medicaid expansion and health insurance exchanges. Reforms to payment and delivery systems are also expected to help slow premium growth and reduce costs over time. Implementation will occur gradually through 2019, with many provisions taking effect in 2014 such as the individual mandate, Medicaid expansion, and state-based insurance exchanges.
The document discusses preventive and case-managed services offered by Nevada Medicaid. It describes how the Affordable Care Act expanded Medicaid coverage in Nevada, increasing the patient population for providers. The two main Medicaid managed care organizations (MCOs) in Nevada, Amerigroup and Health Plan of Nevada, are described as well as some of the preventive services they offer. The document recommends that the MCOs use Medicaid electronic health record incentive programs and encounter data to better monitor screening rates and identify gaps in care for populations. Using this data could help the MCOs improve outreach and preventive service delivery.
This document summarizes research on the impacts of consolidating local health departments (LHDs). It finds that consolidation can yield cost savings through economies of scale and more efficient service provision. Studies of Ohio LHD consolidations found reduced post-consolidation expenditures and up to $1.5 million in annual savings in one case. Consolidation may also improve public health services by enabling LHDs to better perform essential functions. However, the transition process can be disruptive to LHD operations in the short-term. Overall benefits and costs are specific to each situation, requiring local assessments.
Implementing Exchanges that Enhance Choice, Affordability, and Coverage hmartin920
The document discusses the establishment of state-based health insurance exchanges under the Affordable Care Act beginning in 2014. The goal is to expand coverage, slow cost growth, and provide subsidies. Prior state-run insurance cooperatives and purchasing pools had mixed results. Implementing exchanges will be challenging given each state's political environment and the economy. Stakeholders must work together to address complexities of reform.
- Healthcare costs in the US have rapidly increased since the mid-20th century, with spending reaching $2.8 trillion in 2012. Despite high costs, the US healthcare system ranks poorly on outcomes.
- Oregon implemented Coordinated Care Organizations (CCOs) in 2012 to contain Medicaid costs and improve outcomes. CCOs receive a fixed global budget to provide coordinated care through integrated networks.
- Early results show CCOs have decreased emergency room visits and hospitalizations while increasing primary care spending. This shift to preventative care is expected to further reduce costs and improve patient health over time.
Healthcare Reform CHRONIC DISEASE, PREVENTION & QUALITYChristopher Owens
Healthcare reform aims to provide affordable, quality healthcare to all Americans while reducing healthcare spending growth. Key provisions include prohibiting denial of coverage for pre-existing conditions, keeping children on parents' plans until age 26, closing the Medicare prescription drug "donut hole," and fining companies with over 50 employees that do not provide insurance. However, critics argue it may increase insurance premiums and reduce benefits. An important part of reform is Title IV which focuses on preventing chronic diseases through lifestyle changes and screenings in order to reduce healthcare costs and improve public health.
The document discusses provisions of the Affordable Care Act that provide funding to address the primary care provider shortage in the United States. It notes that the ACA invests in expanding the primary care workforce through funding for medical education and support for nurses and nurse practitioners. In particular, it allocates grants and loan repayment programs to nursing schools to boost enrollment and support for students. The document argues this increased funding for primary care training and education is critical to fulfill the goals of the ACA to expand access and improve healthcare outcomes in the face of growing demand for primary care services.
This document discusses primary health care financing reforms in Cameroon. It notes that Cameroon currently relies heavily on out-of-pocket payments for health care, which has led to high rates of catastrophic health expenditures and barriers to access. The document reviews Cameroon's socioeconomic context and history of health policies. It proposes developing a more sustainable financing method to improve access and reduce financial barriers. A literature review defines key concepts in health policy, financing, equity, efficiency, and expenditures to provide context for analyzing alternatives.
This document discusses financing primary health care in Cameroon. It notes that currently, household health financing is mostly done through out-of-pocket payments, which can lead to catastrophic health expenditures and push households into poverty. While Cameroon has social health insurance and community-based insurance programs, coverage remains low, with 62% of Cameroonians lacking access to quality healthcare. The document proposes studying alternative sustainable financing methods to improve access and reduce financial barriers to healthcare.
The document discusses several key issues facing the US healthcare system including rising costs, demographic changes, and quality challenges. It notes that US healthcare costs and spending per capita are the highest in the world. Major drivers of rising costs include high prices, administrative overhead, and high utilization of technology. The Affordable Care Act aims to expand coverage, improve access and quality, and control costs. It establishes insurance exchanges, expands Medicaid, includes an individual mandate, and reforms payments to shift to quality-based systems. Implementation is ongoing from 2010 to 2014 and beyond to transform delivery systems and promote primary care, prevention, and coordinated care models.
The document summarizes the history of healthcare reform efforts in the United States from the early 20th century to the present. It discusses key proposals and legislation over time including those under Theodore Roosevelt, Harry Truman, John F. Kennedy, Lyndon B. Johnson, Richard Nixon, Jimmy Carter, and Barack Obama. It also outlines provisions and goals of the 2010 Affordable Care Act related to expanding coverage, improving the healthcare workforce, lowering costs and improving quality, and how the act is funded. Finally, it discusses the development of the patient-centered medical home model as a joint solution to transform primary care delivery.
1) Accountable care organizations (ACOs) are groups of healthcare providers that coordinate care for patients and are accountable for the quality and costs of that care.
2) The core principles of ACOs are that they are provider-led, have payments linked to quality and cost improvements, and use performance metrics to support care improvements.
3) Compared to earlier HMOs, ACOs focus not just on costs but also on quality of care and patient satisfaction, aiming to achieve the "Triple Aim" of better care, lower costs, and improved health.
This chapter overview describes the goals and essential services of public health institutions and systems in the United States. It identifies the roles of local, state, and federal public health agencies, as well as global health organizations. It also illustrates the need for collaboration between governmental and non-governmental organizations to achieve public health goals.
This document provides an overview of major public health insurance programs in the United States, including Medicaid, CHIP, and Medicare. It discusses eligibility requirements, covered benefits, financing structures, and changes made by the Affordable Care Act. The document also examines quality control measures like licensing and accreditation. It describes efforts to define and improve healthcare quality, as well as legal standards and theories of liability for medical negligence. Federal preemption of state laws by ERISA is also summarized.
This chapter provides an overview of economics concepts relevant to health policy and discusses key provisions of the Affordable Care Act. It covers demand, supply, markets, and why health reform is difficult in the US. It then summarizes previous reform attempts and the major ACA provisions, including the individual mandate, state exchanges, subsidies, employer requirements, insurance regulations, and financing mechanisms.
Compare and contrast conflict visions in healthcareNicole Valerio
Hello Sir
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The document summarizes the Affordable Care Act and identifies some of its flaws and deficiencies. It discusses two main goals of the ACA - to increase the number of insured individuals while reducing overall healthcare costs. However, it notes the ACA has yet to achieve these goals. One deficiency is that individuals who remain uninsured face a penalty fee, which does not actually encourage accessing healthcare. Another issue is the "coverage gap" where many remain uninsured. The document proposes solutions like a state-run program to cover those in the gap and bundled payments to replace fee-for-service. It argues more reform is still needed to control rising costs while expanding access.
A simple overview on heatlhcare costs and reasons why there is a global increase in the field. The presentation concentrates the Omani setting with a comparison to what is available in public reports.
This document summarizes a white paper about integrated benefit programs for dual eligible beneficiaries (those eligible for both Medicare and Medicaid). It discusses the high costs of care for dual eligibles, various existing programs that coordinate Medicare and Medicaid benefits, and features of recent dual eligibility demonstration programs. Key programs mentioned include the Financial Alignment Initiative testing capitated and managed fee-for-service models in 12 states, and State Innovation Model initiatives investing $1 billion in delivery system reforms across 38 states/territories. The document examines guidance from CMS on desired elements of future dual eligibility demonstration programs.
A Road Map For Americas Future by Paul Ryanjenkan04
The document outlines Congressman Paul Ryan's proposal called "A Roadmap for America's Future" which includes reforms to healthcare, Social Security, taxes, and the federal budget. The healthcare section proposes providing tax credits to individuals for purchasing health insurance, creating state-based insurance exchanges, and transitioning Medicaid into a system that provides direct assistance for purchasing private plans. The Social Security reforms give workers under 55 the option to invest some of their payroll taxes into personal retirement accounts. The tax reforms aim to simplify the tax code and lower rates while eliminating special deductions and maintaining progressivity.
This document summarizes a presentation on rising health care costs given to the Joint Commission on Health Care. It outlines that health care costs have been increasing at an average rate of 9.8% annually since 1970. The highest costs are concentrated among the sickest 10% of the population. While health insurance premiums continue to rise more slowly than in the past, they still outpace inflation and wage growth. Efforts to control costs include promoting consumer directed health plans, disease management programs, and reducing medical errors through health information technology.
Relationship Between Fiscal Decentralization and Health Care Financing in Uas...Triple A Research Journal
ABSTRACT
This study examined the relationship between fiscal decentralization and health care financing in Uasin Gishu County Kenya, the researcher sought to answer the following research questions; To what extend does the adequacy of decentralized funds influence health care financing in Uasin Gishu County Kenya? How effective was health management team in influencing health care financing in Uasin Gishu County Kenya? How does budgeting and allocation of decentralized funds affect health care financing in Uasin Gishu County Kenya? Lastly, what were the effects of decentralized fund expenditure on health care financing in Uasin Gishu County Kenya? The researcher used ex-post facto research design. Both stratified sampling and random sampling technique was used to select the respondents. The target population for the study was 98 employees working in health department with a sample size of 79 respondents whom comprised of permanent health workers working in the major hospitals in the county. Questionnaires were employed as the major data collection tools. Data were analysed through descriptive statistics and hypothesis is tested by use of chi square. The analysis of the data was done with Statistical package for social science (SPSS) version 20 and the data was presented though use of graphs and tables for clear understanding of the results. The findings from the study therefore rejected the null hypotheses and concluded that there exists statistically significant relationship between adequacy of decentralized funds, management effectiveness and budgetary mechanism and the level of health care financing. This means that whenever the health management team are effective in managing the decentralized funds well, there is an increase in the level of health care financing.
Keywords: Fiscal Decentralization and Healthcare financing
Linkages Between the Essential Health Services Package and Government-Sponsor...HFG Project
Priority setting is a key function of health systems that seek to achieve universal health coverage. The Essential Health Services Package (EHSP) explicitly prioritizes certain services; government-sponsored health benefit plans implicitly prioritize others. To gain insights into the purpose, policy objectives, and governance of the EPHS and dominant health benefit plans in Ethiopia, we conducted a case study in 2016. Methods included a desk review of relevant documents and qualitative analysis of 15 key informant interviews of leading health finance experts in Addis Ababa. All data were coded and analyzed using a thematic inductive framework.
The document discusses health systems in advanced Asian countries and lessons for Thailand. It covers how Japan, Taiwan, and Singapore organize and finance healthcare through social health insurance models. These systems achieve universal coverage and emphasize preventive care. The document suggests Thailand could improve healthcare quality, efficiency and equity by taking a systems approach while strengthening governance.
The ten predictions for 2020
1. Health consumers in 2020
Informed and demanding patients are now partners in their own healthcare
2. Health care delivery systems in 2020
The era of digitised medicine - new business models drive new ideas
3. Wearables and mHealth applications in 2020
Measuring quality of life not just clinical indicators
4. Big Data in 2020
Health data is pervasive – requiring new tools and provider models
5. Regulation in 2020
Regulations reflect the convergence of technology and science
6. Research and Development in 2020
The networked laboratory - partnerships and big data amidst new scrutiny
7. The pharmaceutical commercial model in 2020
Local is important but with a shift from volume to value
8. The pharmaceutical enterprise configuration - the back office in 2020
Single, global and responsible for insight enablement
9. New business models in emerging markets in 2020
Still emerging, but full of creativity for the world
10. Impact of behaviours on corporate reputation in 2020
A new dawn of trust
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
This document discusses opportunities for collaboration between academia and industry to drive efficiency in research. It notes that while academia traditionally focused on pure research and industry on profit, drug discovery now requires a mixed model with contributions from both. Effective collaborations could help address challenges like rising costs and project attrition. However, differences in culture and goals can hamper partnerships. The document recommends developing focused projects and consortia, addressing intellectual property and conflicts of interest upfront, and managing collaborations strategically like an investment portfolio to maximize their potential for innovation.
Healthcare Reform CHRONIC DISEASE, PREVENTION & QUALITYChristopher Owens
Healthcare reform aims to provide affordable, quality healthcare to all Americans while reducing healthcare spending growth. Key provisions include prohibiting denial of coverage for pre-existing conditions, keeping children on parents' plans until age 26, closing the Medicare prescription drug "donut hole," and fining companies with over 50 employees that do not provide insurance. However, critics argue it may increase insurance premiums and reduce benefits. An important part of reform is Title IV which focuses on preventing chronic diseases through lifestyle changes and screenings in order to reduce healthcare costs and improve public health.
The document discusses provisions of the Affordable Care Act that provide funding to address the primary care provider shortage in the United States. It notes that the ACA invests in expanding the primary care workforce through funding for medical education and support for nurses and nurse practitioners. In particular, it allocates grants and loan repayment programs to nursing schools to boost enrollment and support for students. The document argues this increased funding for primary care training and education is critical to fulfill the goals of the ACA to expand access and improve healthcare outcomes in the face of growing demand for primary care services.
This document discusses primary health care financing reforms in Cameroon. It notes that Cameroon currently relies heavily on out-of-pocket payments for health care, which has led to high rates of catastrophic health expenditures and barriers to access. The document reviews Cameroon's socioeconomic context and history of health policies. It proposes developing a more sustainable financing method to improve access and reduce financial barriers. A literature review defines key concepts in health policy, financing, equity, efficiency, and expenditures to provide context for analyzing alternatives.
This document discusses financing primary health care in Cameroon. It notes that currently, household health financing is mostly done through out-of-pocket payments, which can lead to catastrophic health expenditures and push households into poverty. While Cameroon has social health insurance and community-based insurance programs, coverage remains low, with 62% of Cameroonians lacking access to quality healthcare. The document proposes studying alternative sustainable financing methods to improve access and reduce financial barriers to healthcare.
The document discusses several key issues facing the US healthcare system including rising costs, demographic changes, and quality challenges. It notes that US healthcare costs and spending per capita are the highest in the world. Major drivers of rising costs include high prices, administrative overhead, and high utilization of technology. The Affordable Care Act aims to expand coverage, improve access and quality, and control costs. It establishes insurance exchanges, expands Medicaid, includes an individual mandate, and reforms payments to shift to quality-based systems. Implementation is ongoing from 2010 to 2014 and beyond to transform delivery systems and promote primary care, prevention, and coordinated care models.
The document summarizes the history of healthcare reform efforts in the United States from the early 20th century to the present. It discusses key proposals and legislation over time including those under Theodore Roosevelt, Harry Truman, John F. Kennedy, Lyndon B. Johnson, Richard Nixon, Jimmy Carter, and Barack Obama. It also outlines provisions and goals of the 2010 Affordable Care Act related to expanding coverage, improving the healthcare workforce, lowering costs and improving quality, and how the act is funded. Finally, it discusses the development of the patient-centered medical home model as a joint solution to transform primary care delivery.
1) Accountable care organizations (ACOs) are groups of healthcare providers that coordinate care for patients and are accountable for the quality and costs of that care.
2) The core principles of ACOs are that they are provider-led, have payments linked to quality and cost improvements, and use performance metrics to support care improvements.
3) Compared to earlier HMOs, ACOs focus not just on costs but also on quality of care and patient satisfaction, aiming to achieve the "Triple Aim" of better care, lower costs, and improved health.
This chapter overview describes the goals and essential services of public health institutions and systems in the United States. It identifies the roles of local, state, and federal public health agencies, as well as global health organizations. It also illustrates the need for collaboration between governmental and non-governmental organizations to achieve public health goals.
This document provides an overview of major public health insurance programs in the United States, including Medicaid, CHIP, and Medicare. It discusses eligibility requirements, covered benefits, financing structures, and changes made by the Affordable Care Act. The document also examines quality control measures like licensing and accreditation. It describes efforts to define and improve healthcare quality, as well as legal standards and theories of liability for medical negligence. Federal preemption of state laws by ERISA is also summarized.
This chapter provides an overview of economics concepts relevant to health policy and discusses key provisions of the Affordable Care Act. It covers demand, supply, markets, and why health reform is difficult in the US. It then summarizes previous reform attempts and the major ACA provisions, including the individual mandate, state exchanges, subsidies, employer requirements, insurance regulations, and financing mechanisms.
Compare and contrast conflict visions in healthcareNicole Valerio
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
www.cheapassignmenthelp.com
www.cheapassignmenthelp.co.uk/
The document summarizes the Affordable Care Act and identifies some of its flaws and deficiencies. It discusses two main goals of the ACA - to increase the number of insured individuals while reducing overall healthcare costs. However, it notes the ACA has yet to achieve these goals. One deficiency is that individuals who remain uninsured face a penalty fee, which does not actually encourage accessing healthcare. Another issue is the "coverage gap" where many remain uninsured. The document proposes solutions like a state-run program to cover those in the gap and bundled payments to replace fee-for-service. It argues more reform is still needed to control rising costs while expanding access.
A simple overview on heatlhcare costs and reasons why there is a global increase in the field. The presentation concentrates the Omani setting with a comparison to what is available in public reports.
This document summarizes a white paper about integrated benefit programs for dual eligible beneficiaries (those eligible for both Medicare and Medicaid). It discusses the high costs of care for dual eligibles, various existing programs that coordinate Medicare and Medicaid benefits, and features of recent dual eligibility demonstration programs. Key programs mentioned include the Financial Alignment Initiative testing capitated and managed fee-for-service models in 12 states, and State Innovation Model initiatives investing $1 billion in delivery system reforms across 38 states/territories. The document examines guidance from CMS on desired elements of future dual eligibility demonstration programs.
A Road Map For Americas Future by Paul Ryanjenkan04
The document outlines Congressman Paul Ryan's proposal called "A Roadmap for America's Future" which includes reforms to healthcare, Social Security, taxes, and the federal budget. The healthcare section proposes providing tax credits to individuals for purchasing health insurance, creating state-based insurance exchanges, and transitioning Medicaid into a system that provides direct assistance for purchasing private plans. The Social Security reforms give workers under 55 the option to invest some of their payroll taxes into personal retirement accounts. The tax reforms aim to simplify the tax code and lower rates while eliminating special deductions and maintaining progressivity.
This document summarizes a presentation on rising health care costs given to the Joint Commission on Health Care. It outlines that health care costs have been increasing at an average rate of 9.8% annually since 1970. The highest costs are concentrated among the sickest 10% of the population. While health insurance premiums continue to rise more slowly than in the past, they still outpace inflation and wage growth. Efforts to control costs include promoting consumer directed health plans, disease management programs, and reducing medical errors through health information technology.
Relationship Between Fiscal Decentralization and Health Care Financing in Uas...Triple A Research Journal
ABSTRACT
This study examined the relationship between fiscal decentralization and health care financing in Uasin Gishu County Kenya, the researcher sought to answer the following research questions; To what extend does the adequacy of decentralized funds influence health care financing in Uasin Gishu County Kenya? How effective was health management team in influencing health care financing in Uasin Gishu County Kenya? How does budgeting and allocation of decentralized funds affect health care financing in Uasin Gishu County Kenya? Lastly, what were the effects of decentralized fund expenditure on health care financing in Uasin Gishu County Kenya? The researcher used ex-post facto research design. Both stratified sampling and random sampling technique was used to select the respondents. The target population for the study was 98 employees working in health department with a sample size of 79 respondents whom comprised of permanent health workers working in the major hospitals in the county. Questionnaires were employed as the major data collection tools. Data were analysed through descriptive statistics and hypothesis is tested by use of chi square. The analysis of the data was done with Statistical package for social science (SPSS) version 20 and the data was presented though use of graphs and tables for clear understanding of the results. The findings from the study therefore rejected the null hypotheses and concluded that there exists statistically significant relationship between adequacy of decentralized funds, management effectiveness and budgetary mechanism and the level of health care financing. This means that whenever the health management team are effective in managing the decentralized funds well, there is an increase in the level of health care financing.
Keywords: Fiscal Decentralization and Healthcare financing
Linkages Between the Essential Health Services Package and Government-Sponsor...HFG Project
Priority setting is a key function of health systems that seek to achieve universal health coverage. The Essential Health Services Package (EHSP) explicitly prioritizes certain services; government-sponsored health benefit plans implicitly prioritize others. To gain insights into the purpose, policy objectives, and governance of the EPHS and dominant health benefit plans in Ethiopia, we conducted a case study in 2016. Methods included a desk review of relevant documents and qualitative analysis of 15 key informant interviews of leading health finance experts in Addis Ababa. All data were coded and analyzed using a thematic inductive framework.
The document discusses health systems in advanced Asian countries and lessons for Thailand. It covers how Japan, Taiwan, and Singapore organize and finance healthcare through social health insurance models. These systems achieve universal coverage and emphasize preventive care. The document suggests Thailand could improve healthcare quality, efficiency and equity by taking a systems approach while strengthening governance.
The ten predictions for 2020
1. Health consumers in 2020
Informed and demanding patients are now partners in their own healthcare
2. Health care delivery systems in 2020
The era of digitised medicine - new business models drive new ideas
3. Wearables and mHealth applications in 2020
Measuring quality of life not just clinical indicators
4. Big Data in 2020
Health data is pervasive – requiring new tools and provider models
5. Regulation in 2020
Regulations reflect the convergence of technology and science
6. Research and Development in 2020
The networked laboratory - partnerships and big data amidst new scrutiny
7. The pharmaceutical commercial model in 2020
Local is important but with a shift from volume to value
8. The pharmaceutical enterprise configuration - the back office in 2020
Single, global and responsible for insight enablement
9. New business models in emerging markets in 2020
Still emerging, but full of creativity for the world
10. Impact of behaviours on corporate reputation in 2020
A new dawn of trust
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
This document discusses opportunities for collaboration between academia and industry to drive efficiency in research. It notes that while academia traditionally focused on pure research and industry on profit, drug discovery now requires a mixed model with contributions from both. Effective collaborations could help address challenges like rising costs and project attrition. However, differences in culture and goals can hamper partnerships. The document recommends developing focused projects and consortia, addressing intellectual property and conflicts of interest upfront, and managing collaborations strategically like an investment portfolio to maximize their potential for innovation.
Healthcare as an industry is experiencing dramatic change in its IT landscape. A very important factor for Healthcare IT is to comply with critical healthcare compliances like HIPAA and making investments in computer systems and software and their security more important than ever. As well in order to improve the quality of care there is an absolute need of integrated and collaborative systems providing patient information and medical reference knowledge to the medical decision makers at the point of clinical decision making.
Few more critical drivers for the changes are:
- Government regulations and initiatives to bring down the healthcare costs,
- Demand for patient centric systems
- Increasing patient awareness
Considering the specific needs of the Healthcare industry and based on our extensive research findings Optimus BT has chalked out a overall presentation to provide an overview of the state of Healthcare ecosystem and the ways to make it more efficient and effective to improve quality of care. We have tailored our solution to meet the needs in the most comprehensive way using Microsoft SharePoint 2010 as a platform. Our solution portfolio encompasses Physician portal, hospital intranets, patient portal, Collaboration portal for healthcare etc. We ensure that the value delivered through our solution create unique value proposition for our customers and their stakeholders across the Healthcare value chain.
This document provides an overview of multiple sclerosis (MS), including its epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment. Some key points:
1. MS typically affects people between the ages of 15-45 and is more common in women. It has a variable geographic distribution and prevalence of around 0.1% in the US.
2. The pathophysiology involves chronic inflammation and demyelination in the central nervous system resulting in neurological deficits. MRI is an important tool for diagnosis and monitoring disease progression.
3. Clinical symptoms can include visual disturbances, motor and sensory problems, fatigue, and cognitive issues. Relapsing-remitting is the most common disease course.
The document discusses issues with the current US healthcare system and proposes solutions. It notes that the system incentivizes overuse of services due to fee-for-service payments. It also discusses collecting standardized data on procedures and prices to enable comparisons and drive costs down. The document proposes building an economic model and running scenarios to optimize strategic choices and improve quality and processes.
Us health care system final presentation.Wendi Lee
Wendi Evans is pursuing a degree in health care administration. This presentation will provide an overview of the history and current state of the US healthcare system, including defining key terms, outlining milestones from 1900 to present, comparing the US system to Canada's, and discussing reforms and stakeholders. The summary will discuss the establishment of organized medicine in the US in the 1900s, the passage of Medicare and Medicaid in the 1960s, the implementation of the Affordable Care Act in 2010, and reforms aimed at improving quality and lowering costs.
Strategic Planning For Healthcare Servicesalberpaules
This document provides an overview of strategic planning for healthcare services. It defines key terms like strategy and strategic leadership. It discusses Dell Computer's successful business model as a case study. It also outlines the strategic planning process, including selecting organizational statements, strategic goals, and doing external and internal analysis. The purpose is to help managers formulate strategies that give their organizations a competitive advantage.
Achieving Health Care Reform in the United States Toward a Whole-System Und...Suzanne Simmons
The document discusses health care reform in the United States and proposes a system dynamics approach. It provides context on the types of reforms attempted, including expanding access, containing costs, improving quality, and protecting health. Past reforms have been piecemeal and failed to address the full scope of problems or satisfy all stakeholders. The authors develop causal loop diagrams to explain the development and problems of the US health care system, assess past reform efforts, and consider future reform possibilities through a system dynamics lens.
SOCW 6351 Wk 9 Discussion 1. Need Responses.Respond in one of t.docxrosemariebrayshaw
SOCW 6351 Wk 9 Discussion 1. Need Responses.
Respond in one of the following ways:
· Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
· Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Support your response with specific references to the resources. Be sure to provide full APA citations for your references.
NA:
Top of Form
Medicaid is a medical assistance program developed specifically for low income individuals of any age, unlike Medicare, which is designed for those over 65 and have no income requirements (“Difference between Medicare and Medicaid”, n.d.). When health care policies are change, they affect programs such as Medicaid and Medicare. For example, when the ACA (Affordable Care Act) was implemented, it led to an increase of enrollment as it made the process easier and reached more individuals and it expanded Medicaid eligibility to low-income adults (Wachino, Artiga & Rudowitz, 2014).
In the state of Pennsylvania, a Medicaid policy that I would amend would be the Healthy PA policy, which was a Medicaid expansion that included drug and alcohol services (IRETA, 2015). The issue is the length of time it takes for someone to be admitted into a program. Whether it’s getting into an inpatient or outpatient program, the process needs to be expedited and more streamlined. Many who are suffering from substance abuse disorders struggle with finally getting themselves into a program and delaying the process could result in someone hesitating and deciding not to move forward with treatment that is crucial (IRETA, 2015).
In Pennsylvania, stakeholders include a steering committee, which is made up of hospitals, health care providers, consumers, foundations and academic institutions (“HIP”, 2019). This committee comes up with ways to improve population health and control health cost including Medicaid and Medicare. They developed a plan for heathcare delivery that will improve the quality of life for everyone, without limitations on income or background (“HIP”, 2019). This committee has 5 work groups that develop implementation plans for the goals that were developed by the committee and focus on specific aspects such as payment, price and quality transparency, population health, healthcare transformation and health information technology (“HIP”, 2019).
References:
HIP stakeholders. (2019). Retrieved from https://www.health.pa.gov/topics/Health-Innovation/Pages/Stakeholders.aspx
IRETA. (2015). Pennsylvania’s Medicaid expansion smooths the road to addiction treatment, but barriers remain. Retrieved from https://ireta.org/resources/pennsylvanias-medicaid-expansion-smooths-the-road-to-addiction-treatment-but-barriers-remain/
Wachino, V., A.
Implications for The Medicare Program Discussion.docx4934bk
This document discusses implications for the Medicare program given demographic trends in the aging US population. It outlines 10 issues arising from an increasing senior population and the implications for Medicare delivery and costs. It also discusses potential solutions to issues providing healthcare for seniors, including maintaining the political and fiscal viability of Medicare in the future.
Running Head HEALTHCARE STAKEHOLDER CONFLICTS1HEALTHCARE .docxcowinhelen
Running Head: HEALTHCARE STAKEHOLDER CONFLICTS
1
HEALTHCARE STAKEHOLDER CONFLICTS
5
Stakeholder Conflicts in Healthcare Visions
Kendra Smith
Grand Canyon University: HCA 675
Introduction
The stakeholders in the healthcare service in any jurisdiction entail the government, the healthcare providers or the physicians, the payers, the patients as well as healthcare professional organizations.
These stakeholders work hand in hand to ensure efficiency and professionalism in healthcare delivery (Blair et al, 1988). They do this by developing succinct policies and effectively implement them for the sole purpose of improving healthcare services. However, there have been serious conflicts in opinion regarding enhancing healthcare service practices and proper administrative mechanisms for the achievement of better services, among the stakeholders.
Conflicts in Health Vision
One of the major health reform visions which have generated considerable debate concerns the accommodation of evidence-driven healthcare service practice, which the government of the United States has instructed all healthcare service providers or organizations to adopt. The major emphasis on this aspect of medicine is the requirement by the government that all healthcare service providers or organizations should document which healthcare services they provide and why they provide such healthcare services to the communit
y.
The argument behind this requirement is that it will enable the government, or it will be generally helpful in gauging the benefits the community gains from such healthcare services. In addition, establishing evidence-driven healthcare practice according to healthcare practitioners will help in identifying specific health problems within a community, and subsequently, design the most appropriate medical response. Some healthcare stakeholders also believe that this is an avenue that the government intends to use in creating and forging a closer working relationship between private and public healthcare providers. However much most stakeholders, both private and public, appreciate this evidence-based healthcare practice, as a vital component in improving healthcare services, the major concern is about how such data should be obtained. Some healthcare providers have reasoned that these data should be generated from the already existing data, due to the costs associated with activities that may lead to acquiring and establishing sound data or information domain. In response to this requirement, most of the healthcare organizations have established community-based information or data collection and management mechanisms, which enable them to collect data concerning community health concerns and threats, then define effective ways of response.
With the introduction and implementation of a series of healthcare reforms in the United States, such as the Obamacare and Trumpcare, there is general expectation that there will be enhanced access to healthcare service ...
The document discusses Accountable Care Organizations (ACOs) which were created by the Affordable Care Act to improve quality and lower costs. It provides frequently asked questions about ACOs, including whether they are viable, how providers can save money through ACOs, examples of successful ACO programs like Marshfield Clinic, and the healthcare IT components needed to support ACOs. Providers are encouraged to invest in quality, innovation, and data/analytics to prepare for value-based payment models like ACOs.
Unintended Consequences of Health Care ReformThe PPACA of .docxgibbonshay
Unintended Consequences of Health Care Reform
The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.
Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.
To prepare:
Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.
Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization?
With posting instructions in mind, select either the individual mandate or accountable care organizations as the focus of your Discussion this week.
By tomorrow Wednesday 03/07/18 BY 12pm, write a minimum of 550 words in APA format with a minimum of
THREE
scholarly references from the list of required readings below. Include the level one headers as numbered below:
Post
a cohesive response that addresses the following:
1) In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.
2) Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession ( I WORK I A HOSPITAL SETTING).
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.
Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”
Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”
McClellan, M. (2010). Accountable care organizations in the era of health care reform. American Health & Drug Benefits, 3 ...
This document discusses the history and evolution of health insurance in America, including the impact of the Affordable Care Act (ACA). It describes how the ACA sought to regulate health insurance policies, provide coverage to all Americans, and reduce costs. It also examines effects on quality of care, such as the emphasis on accountable care organizations and reducing hospital readmissions. The future of the industry is discussed in terms of ongoing consolidation through mergers and the potential disruption from non-traditional players entering the market.
Market Power, Transactions Costs, and the Entryof Accountabl.docxinfantsuk
Market Power, Transactions Costs, and the Entry
of Accountable Care Organizations in Health Care
H. E. Frech III.1 • Christopher Whaley2 •
Benjamin R. Handel3 • Liora Bowers4 •
Carol J. Simon5 • Richard M. Scheffler6
Published online: 15 July 2015
� Springer Science+Business Media New York 2015
Abstract ACOs were promoted in the 2010 Patient Protection and Affordable
Care Act (ACA) to incentivize integrated care and cost control. Because they
involve vertical and horizontal collaboration, ACOs also have the potential to harm
competition. In this paper, we analyze ACO entry and formation patterns with the
use of a unique, proprietary database that includes public (Medicare) and private
ACOs. We estimate an empirical model that explains county-level ACO entry as a
function of: physician, hospital, and insurance market structure; demographics; and
other economic and regulatory factors. We find that physician concentration by
organization has little effect. In contrast, physician concentration by geographic
Earlier versions of this paper were presented at the International Industrial Organization Conference in
Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science
meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life
Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially
Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra
Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley
for helpful comments on earlier versions and to the referees and editor of this journal for more recent
useful comments.
& H. E. Frech III.
[email protected]
Christopher Whaley
[email protected]
Benjamin R. Handel
[email protected]
Liora Bowers
[email protected]
Carol J. Simon
[email protected]
1
Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106,
USA
123
Rev Ind Organ (2015) 47:167–193
DOI 10.1007/s11151-015-9467-y
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
site—which is a new measure of locational concentration of physicians—discour-
ages ACO entry. Hospital concentration generally has a negative effect. HMO
penetration is a strong predictor of ACO entry, while physician-hospital organiza-
tions have little effect. Small markets discourage entry, which suggests economies
of scale for ACOs. Predictors of public and private ACO entry are different. State
regulations of nursing and the corporate practice of medicine have little effect.
Keywords Health care competition � Antitrust � Entry � Integration � Accountable
care organizations � Transactions costs � Obama plan
JEL Classification L 14 � I11 � L44 � I18 � L41
1 Introduction and Overview
The US health car ...
The document provides an overview of accountable care organizations (ACOs) including:
1) ACOs aim to tie provider reimbursements to quality and reduce total cost of care for assigned patients.
2) Key stakeholders include providers, payers (primarily Medicare), and patients (primarily Medicare beneficiaries).
3) The concept of ACOs originated in 2006 but builds on prior models. Successful implementation remains challenging.
4) The Patient Protection and Affordable Care Act supports the development of ACOs and other innovative models.
Assignment 1Public Administration – The Good, th.docxtrippettjettie
Assignment 1
Public Administration – The Good, the Bad, the Ugly
hhhhhhh
Modern Public Administration
Prof. hhhhh
Date: hhhhh
The White House Issue: Health reforms
The Health Care Reforms are the best obsession for the United States, Majorly most of the American citizens who were responsible for originating the improvement found it helpful. Back in the year 2011, a countrywide crackdown was conducted as a way to oppose the frauds that were becoming a health concern, and the federal administration recovered almost $ 4.1 billion. The Health Care Improvement for capturing the healthcare frauds and scams allowed President Obama’s policy to enhance on strict penalties like compensation and fines. By providing the United States citizens with Patient Protection as well as, ACA (Affordable Care Act) was the ultimate presidential success for President Barack Obama (.whitehouse., 2014).
The public policy
As most of the leaders decided to adopt a firm stand with the many important issues within the American State, the essential point was the definition of the improvement of the Health Care in the United States by President Barack Obama and when discussing the fitness and care reform a lot of issues are put on focus.
The public policies are categorized into four groups which are the regulatory policy, the distributive policy, the redistributive policy and lastly the constituent policy. Every issue in the White House is organized it the way it is related to any of the four types of public systems (NCBI, 2016). The financial regime faces most of the significant issues, and many may need to be in a position to determine the problems which are related to funding system because some of these issues affect some of the American citizens.
Distributive policy as mentioned above, it is a policy that focuses on supporting the selected issues; the strategy that is behind the distributive health care is the local understanding and having a flexible organizational design. The idea of distribution is quite broad as it classifies distributive policy action towards including all the public processes that are responsible for developing as well as providing equitable access to the resources. In regards to the health issues, this may have financial aid for assisting the excluded to have access to the healthcare. Also, across funding aid to assist in the inside operations of the health institutions such as the combination of threats which enhances the inclusion of reasonably inadequate health services. Also, the appointment systems facilitate the secondary concern for the needy to access health services (Mackintosh, 2013). It also reduces the shifts regarding the fitness care regime in processes that will be able to satisfy and offer the proper access to those who are deprived by supporting the distributive promises that the government has made and having full access to healthcare services. In this kind of shift, the significant disadvantage is ...
The document discusses recent healthcare reforms in the United States and their potential impacts. It notes that the Patient Protection and Affordable Care Act aims to increase insurance coverage while lowering costs. Additionally, the HITECH Act promotes the meaningful use of IT in healthcare to improve quality and reduce spending. Major effects may include 45-55 million Americans gaining insurance, increased use of electronic health records and pay-for-performance programs between providers and payers. Overall the reforms seek to align financial incentives around improved patient outcomes and care coordination.
Study Guide Health Care ReformHealth Care Reform OverviewWhe.docxpicklesvalery
Study Guide: Health Care Reform
Health Care Reform: Overview
When it comes to healthcare in America, we seem to believe that more is better--but does more healthcare result in better health? As a nation, we spend more on healthcare per person than any European country, yet our health outcomes are worse. The PBS documentary, Money and Medicine was aired in 2012, and addresses one of the key issues of healthcare reform--the cost of health care. Watch the trailer below, or the entire episode here: http://video.pbs.org/video/2283573727/
(Links to an external site.)
http://youtu.be/a9oEtRwoVxs
(Links to an external site.)
The Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), passed in 2010, is a collection of laws that were created to reform health insurance and healthcare.
The ACA significantly impacts nurses both personally and professionally. Bedside nurses are impacted by organizational changes that affect patient care, and may be providing information and resources to patients and caregivers about the ACA. However, as Hynds, Hatch and Samuels (2014) noted, nurses indicate they need more knowledge to understand the ACA policy implications of their practice.
Now, you can either read the 974 pages of the law itself, or you can watch this short, animated video produced by the Kaiser Family Foundation, and visit the helpful online resources below:
http://youtu.be/JZkk6ueZt-U
(Links to an external site.)
The YouToons Get Ready for Obamacare
0:01 / 6:52
<div class="player-unavailable"><h1 class="message">An error occurred.</h1><div class="submessage"><a href="http://www.youtube.com/watch?v=JZkk6ueZt-U" target="_blank">Try watching this video on www.youtube.com</a>, or enable JavaScript if it is disabled in your browser.</div></div> Minimize Video
Affordable Care Act: Five Years Later
The Commonwealth Fund has developed several online, interactive resources to illustrate the impact of the Affordable Care Act in its first five years of implementation. Through personal stories, population and health systems data analysis, and graphics, the Commonwealth fund paints the picture of the impact of the ACA on individuals, businesses, providers and healthcare systems. Take some time to explore these resources in preparation for this week's discussion board. Link: The Affordable Care Act: A Look Back at the First Five Years.
(Links to an external site.)
Review the two interactive digital features: Coverage Reform
(Links to an external site.)
and Delivery Reform
(Links to an external site.)
.
Value-Based Purchasing--"Pay for Performance"
Increasingly, hospitals and healthcare providers are reimbursed not just for the amount of services provided (fee-for service), but for the results that are achieved for a particular patient population. As nurses, you may have observed policy changes that emphasize patient experience, prevention of hospital-acquired infections, and effective discharge planning ...
5 wk HCS440 Legislations Influence in Health Care & what Changes finalMaile Andrus
The document discusses various pieces of health care legislation and their influence on the U.S. health care system. It addresses the Welfare Reform Act of 1996, the Health Insurance Portability and Accountability Act (HIPAA), and the Affordable Care Act of 2010. It also examines tools from the Centers for Disease Control and Prevention for analyzing economic impacts. Finally, it proposes some potential changes that could be made to legislation to help combat rising health care costs and make the Affordable Care Act more affordable.
The document discusses the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare. It established protections for American citizens to make healthcare more affordable and accessible. The PPACA provides subsidies to lower costs and requires insurance companies to spend a minimum percentage on actual healthcare. It also increased the number of insured Americans, leading to a higher demand for physicians and changes in how hospitals are funded.
The document discusses Accountable Care Organizations (ACOs) created by the Affordable Care Act. ACOs allow groups of doctors, hospitals, and other providers to share responsibility for the cost and quality of care received by their patients. If ACOs meet quality benchmarks and reduce costs, they receive a share of the savings from insurers. The document outlines key features of ACOs such as local accountability, shared savings based on quality and cost measures, and a minimum of a 3-year contract period with Medicare.
CBO provides summaries of its health care analysis methods and recent work. It evaluates health care proposals using a 10-year horizon, examining insurance coverage, health care spending projections, and more. Recent reports analyzed the uninsured, health care prices, and single-payer proposals. CBO also provides cost estimates and scores legislation on issues like surprise billing, the ACA, Medicare expansions, and drug pricing. It describes how it uses modeling, behavior assumptions, and a 10-year window in its analyses.
An Accountable Care Organization (ACO) is a provider-led organization that manages the full continuum of care for a defined patient population to improve quality and reduce costs. The US healthcare system lacks coordination and incentives for value over volume, motivating ACO development. ACOs differ from 1990s integrated delivery systems by focusing on managing performance risk rather than insurance risk through tools like bundled payments, quality tracking, and health IT. Critical functions include attributing patients, budgeting, performance measurement, and managing payment models to distribute shared savings incentives.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
Second essayTopic Monopoly in the united state of America.docx
The Significance and Function of Accountable Care Organizations
1. ShepherdUniversity
The Significance and Functionof
Accountable Care Organizations as a
Vital Component of the Affordable
Care Act and Health Care Reform
A Discussion of the Development,
Performance, and Importance of ACOs
Philip McCarley
2/23/2015
2. 1
Introduction
During the past century attempts to reform the basic structure, financing and delivery of
health care in the United States met with great resistance from political and business
stakeholders. Berkowitz provided a thorough historical review and analysis of “the
transformation of the idea behind national insurance during the period from 1900 to 1965”
(Berkowitz, 2008). Since the historic passage of Medicare and Medicaid in 1965 the complexity
and the cost of providing care has grown steadily and rapidly. With the increasing costs and
strain on the system, particularly with the demographic fact of the aging of the baby boom
generation, the necessity of addressing and reforming the health care system was not in dispute
by most political, economic and public policy observers. Despite the recognition that there
needed to be changes in the health care system, there was passionate, ideological and partisan
disagreement about what actions and changes were acceptable.
An analysis of the recurring historical pattern of attempts to reform health care and
insurance coverage showed that the issue came to the forefront of political and legislative debate
in a cyclical pattern across the entire 20th century (Berkowitz, 2008). The most recent chapter of
this repeated push for health care reform, prompted by ever increasing numbers of uninsured
Americans and ever increasing cost of health care and health insurance, culminated in the
successful passage of the Affordable Care Act (ACA) of 2010. In face of strong and persistent
opposition, the ACA continues to survive legal and political challenges and continues to move
forward with implementation of reforms.
With so much contentious debate about some of the other provisions of the ACA, there
has been relatively little focus by media and politicians on the sections of the ACA that
mandated the creation and development of Accountable Care Organizations (ACOs). Simply
3. 2
stated “the key idea is that the ACO has financial incentives to improve quality based on
predefined criteria and keep overall costs within a target budget” (Shortell, Wu, Lewis, Colla, &
Fisher, 2014, p. 1884). Summarizing the intent inherent in the inclusion of ACOs as an integral
part of reform, Devore & Champion observe that “the Affordable Care Act embraced ACOs as
one way to foster the transition from a disjointed, siloed health care system to one that is better
coordinated and aligned to provide far more value to patients, providers, and payers” (DeVore &
Champion, 2011). This paper will review the history and aims of the concept of ACOs, discuss
the provisions of the ACA related to ACOs, and consider development, significance and
performance of ACOs since the passage of the ACA in 2010.
History and aims of the ACO concept
The framework for the concept of accountable care organizations has precedents in
previous attempts to control costs through efforts such as health maintenance organizations
(HMOs) and through previous attempts to improve and integrate care such as integrated delivery
systems (IDSs).
Although similar in many respects, the function, structure, incentives and aims of these
precedents are not the same as the proposed function, structure, incentives and aims of ACOs.
In fact, the current manifestation of the Center for Medicare & Medicaid Services (CMS)
reforms under the Medicare Shared Savings Program (MSSP) mandated by the ACA, ACOs
have more kinship and direct relationship to the Physician Group Practice Demonstration Project
(PGP). The PGP was mandated by the Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000, was conducted between 2005 and 2010, and was extended for two
4. 3
additional years through 2012. The final report on the PGP, published September 2013,
discusses the lessons learned from this project related to pay for performance and quality
improvement initiatives of CMS (RTI International, 2012). The timely 2012 overlap of the
ending of the PGP with the initiation of the MSSP allowed for a continuity and flow of programs
with nearly identical aims and philosophy with regard to the evolving pay models for Medicare
reimbursement.
Prior to the passage of the ACA and the implementation by CMS of the provisions
related to ACOs Berwick, Nolan, & Whittington contended:
Improving the U.S. health care system requires simultaneous pursuit of three
aims: improving the experience of care, improving the health of populations, and
reducing per capita costs of health care. Preconditions for this include the
enrollment of an identified population, a commitment to universality for its
members, and the existence of an organization (an ‘integrator’) that accepts
responsibility for all three aims for that population. The integrator’s role includes
at least five components: partnership with individuals and families, redesign of
primary care, population health management, financial management, and macro
system integration (Berwick, Nolan, & Whittington, 2008).
The treatment these three aims as interdependent and pursued as a whole and unified strategic
purpose is essential (Berwick, Nolan, & Whittington, 2008). Furthermore, Donald Berwick, the
lead author of the above referenced article, served as Administrator of the Centers for Medicare
and Medicaid Services (CMS) from July 2010 to December 2011 through a recess appointment
by President Obama. His expressed ideas regarding the aims, intent, and potential significant
role of ACOs match the intent of the law and reveal alignment with the way that CMS and the
Department of Health and Human Services (HHS) are implementing the ACA with regard to
ACOs. Berwick noted that “the creation of ACOs is one of the first delivery-reform initiatives
that will be implemented under the [Affordable Care Act]. Its purpose is to foster change in
5. 4
patient care so as to accelerate progress toward a three-part aim: better care for individuals, better
health for populations, and slower growth in costs through improvements in care” (Berwick D.
M., 2011).
Also prior to the passage of the ACA, the proposal for Medicare to move toward this type
of “payment reform model” was expressed clearly by Elliot Fisher, director of the Center for
Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, joined
by other scholars and experts:
To succeed, health care reform must slow spending growth while improving
quality. We propose a new approach to help achieve more integrated and efficient
care by fostering local organizational accountability for quality and costs through
performance measurement and “shared savings” payment reform. The approach is
practical and feasible: it is voluntary for providers, builds on current referral
patterns, requires no change in benefits or lock-in for beneficiaries, and offers the
possibility of sustained provider incomes even as total costs are constrained. We
simulate the potential expenditure impact and show that significant Medicare
savings are possible. (Fisher, et al., 2009).
In fact they cite the use of the term “accountable care systems” by Shortell & Casalino to refer to
delivery systems that simultaneously organize “processes for improving quality” and are “held
accountable for quality and costs” (Shortell & Casalino, 2008). Over the course of just a few
years the concept of accountable care has grown dramatically in acceptance, use, and application.
Devore & Champion describe the goals and potential of ACOs in this way:
Overall, the goals of an ACO are to empower people to take charge of their health
and engage in shared decision making with providers; eliminate waste and
unnecessary spending while also meeting patients’ preferences for care; increase
preventive care and other strategies that could help keep people well; and increase
overall satisfaction with care. ACOs could also provide incentives for clinical
integration by offering financial rewards to caregivers who work cooperatively to
provide a continuum of care and achieve agreed-upon measures of success
(DeVore & Champion, 2011).
6. 5
With these ideas and proposals giving context and providing guidance to both the
formation and the implementation of the ACA, CMS summarized the three objectives of MSSP-
ACOs with the following specific description:
Better overall care in a safe environment, equitable to all who seek it, and always
available when needed.
Improved health accomplished through the practice of proactive, preventive
medicine and chronic care coordination.
Lower per capita cost aimed at reducing the trending of medical costs associated
with the Original Medicare population (often referred to as "Medicare Fee-for-
Service") (Triple Aim Objectives, 2012).
Within this broader framework of objectives CMS has focused on four key areas of emphasis for
quality standards: patient satisfaction, care coordination, preventive health, and care for chronic
illness.
The role of ACOs in the reforms of the ACA
Title III of the ACA carries the heading and contains provisions related to “Improving the
Quality and Efficiency of Health Care.” Section 3022 of Title III directed the Secretary of the
Department of Health and Human Services (HHS) to “establish a shared savings program that
promotes accountability for a patient population…and encourages investment in infrastructure
and redesigned care processes for high quality and efficient service delivery” (Patient Protection
and Affordable Care Act, 2010). Through the Medicare Shared Savings Program (MSSP)
created by HHS, eligible health care providers and suppliers serving Medicare beneficiaries who
7. 6
meet specified requirements and who agree to participate in the program must agree to be
“accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries
assigned to it” (Patient Protection and Affordable Care Act, 2010). A participating ACO is
required to “define processes to promote evidence-based medicine and patient engagement,
report on quality and cost measures, and coordinate care, such as through the use of telehealth,
remote patient monitoring, and other such enabling technologies” (Patient Protection and
Affordable Care Act, 2010). In addition to receiving the payments of the original fee-for-service
program, participating MSSP-ACOs become eligible to receive additional shared payments for a
portion of demonstrated savings. Once savings reach designated, benchmarked levels, the
created performance and practice savings are essentially “shared” by the MSSP-ACO and the
Medicare program. CMS reported the following update on the status and participation of ACO
established as part of the Medicare Shared Savings Program since the inception of this mandated
ACA program:
“Since passage of the Affordable Care Act, more than 360 Medicare ACOs have
been established, serving over 5.6 million Americans with Medicare. Medicare
ACOs are groups of providers and suppliers of services that work together to
coordinate care for the Medicare fee-for-service (FFS) beneficiaries they serve
and achieve program goals; Medicare ACOs choose a level of performance risk
and receive financial incentives based on that choice and their quality
performance” (Center for Medicare and Medicaid Services, 2014).
It is important to note that there is not simply one type or one model of ACO. In fact,
ACOs are formed and operate under different categories, use different models, and serve
different and distinct groups and populations of patients. Broadly speaking ACOs may be
formed in response to public policy and payer reforms such as has been described with MSSP.
Many are focused on primary care services, care of specialty populations, care of populations
with specific chronic diseases, Medicaid, underserved, and safety-net populations. There has
8. 7
also been observed some movement in state, commercial, and private payer programs toward
ACOs and principles intended to shift toward new health care payer models that reflect and
incorporate the goals of improved quality, better coordination of care and service, greater
engagement with patients in treatment planning and support, increased efficiency, and reduced
costs.
Although most attention has been focused on the ACOs related to the MSSP provision,
the CMS identifies other types of ACOs which are a part of the efforts and strategy of CMS.
In addition to MSSP-ACOs CMS also is working with the Pioneer ACO Model (designed for
selected integrated early participants in coordinated care models) and an Advance Payment ACO
Model (a supplementary incentive program for selected primary care, smaller, or rural providers
to provide support toward developing a model of accountable care). CMS has shown particular
focus on primary care service, prevention, management of chronic illness, specialty populations,
as well as at-risk and underserved populations. Title II Section 2706 of the ACA mandated a
Pediatric Accountable Care Organization Demonstration Project focusing on studying and
improving care for children with special medical needs. This particular project is scheduled to
run for a five year period that is set to end at the end of 2016.
Among the many types of ACOs that have developed over the past few years some are
focused on primary care, some on serving Medicare and/or Medicaid patients, some are focused
on serving specialty populations of patients with specific chronic health conditions, some are
focused on serving larger, general groups of patients and communities providing integrated
health care services across the care continuum. In addition to recently developing ACOs that are
formed around contracting with public payers such as Medicare and Medicaid programs
administered through CMS, ACOs are also developing which have established contractual
9. 8
relationship with private, commercial payers. Recent research reports indicate that
approximately half of existing ACOs had a contract with a private payer. Contracts with private
payers were usually set up as shared savings models, and most private contracts included
downside risk. This study also reported that ACOs with private contracts tended to be larger and
more complex organizations overall than the typical ACOs that did not have private contracts
(Lewis, Colla, Schpero, Shortell, & Fisher, 2014). The Accountable Care Implementation
Collaborative is a private project of the Premier healthcare alliance. Formed in 2010, this
collaborative “consists of health systems that seek to pursue accountability by forming
partnerships with private payers to evolve from fee-for-service payment models to new, value-
driven models” and to develop “best practices that can inform the implementation of accountable
care organizations as well as public policies” (DeVore & Champion, 2011).
Characteristics and taxonomies of ACOs
In attempting to understand the nature, distinctiveness, and effectives of ACOs,
researchers are beginning to classify ACOs according to particular characteristics. Following the
passage of the ACA, early observations about the development of ACOs noted the following 5
patterns:
1. Dispersion of ACOs varies by market.
2. Specific regions of the U.S. are lacking in ACOs.
3. Hospitals and hospital systems are the main backers of ACOs.
4. Investments in the ACO model exist independently of the Medicare Shared
Savings Program.
5. The success of different ACO models is still unproven.
(McNickle, 2011).
10. 9
Several research groups have conceptualized and developed specific “taxonomies” that will
allow for more precise discussion, research, and analysis regarding the organization and
performance of ACOs (Fisher, Shortell, Kreindler, Van Citters, & Larson, 2012; Shortell, Wu,
Lewis, Colla, & Fisher, 2014; Colla, Lewis, Shortell, & Fisher, 2014; Muhlestein, Gardner,
Merrill, Petersen, & Tu, 2014). Recognizing early the rapidly shifting landscape caused by this
alternate care delivery and payment model, Fisher et al. discussed the need for a framework for
understanding, tracking, and monitoring the formation, development and performance of ACOs
(Fisher, Shortell, Kreindler, Van Citters, & Larson, 2012). As they tracked course of early
ACOs, they identified “the major factors—such as contract characteristics; structure, capabilities,
and activities; and local context—that would be likely to influence ACO formation,
implementation, and performance” (Fisher, Shortell, Kreindler, Van Citters, & Larson, 2012).
Through devising a framework for evaluating these pioneer organizations, they hoped to be able
to provide contextual information and guidance to decision-makers and policy makers that would
contribute to the success and effectiveness of succedent ACOs (Fisher, Shortell, Kreindler, Van
Citters, & Larson, 2012).
The work of analysis and study of ACOs has continued to advance along with the rapid
increase in the number and diversification in variety of ACOs. One way that ACOs can be
differentiated is by role of physicians in the administrative leadership of the organization:
physician-led versus non-physician led ACOs (Colla, Lewis, Shortell, & Fisher, 2014). In a
recent detailed study that analyzed current numbers, structures, characteristics and functions of
ACOs, Shortell et. al. used resource dependence theory and institutional theory combined with
analysis of the following eight specific measures:
11. 10
the ACO’s size, number of different types of participating provider organizations
within the ACO (including nursing or postacute care facilities), the scope of
services offered, whether the ACO belongs to an integrated delivery system
(IDS), the percent of primary care clinicians, their institutional leadership model,
the performance management system used for accountability, and the ACO’s
prior experience with payment models other than fee-for-service (Shortell, Wu,
Lewis, Colla, & Fisher, 2014).
From their extensive research and analysis they identified “a reliable and internally valid three-
cluster” taxonomy consisting of three broad categories of ACOs: “integrated delivery system
ACOs,” “smaller, physician-led ACOs,” and “hybrid ACOs” (Shortell, Wu, Lewis, Colla, &
Fisher, 2014). Most typically integrated delivery system ACOs “offer a broad scope of services
and frequently include one or more postacute facilities;” smaller, physician-led ACOs
generally were focused on primary care service delivery and were characterized by “a relatively
high degree of physician performance management;” and hybrid ACOs tended to be a mixture or
combination of “moderate sized, joint hospital-physician and coalition-led groups that offer a
moderately broad scope of services with some involvement of postacute facilities” (Shortell, Wu,
Lewis, Colla, & Fisher, 2014). They assert that this taxonomy can serve as a valuable tool “to
describe and understand early ACO development and to provide a basis for technical assistance
and future evaluation of performance” (Shortell, Wu, Lewis, Colla, & Fisher, 2014).
Furthermore, they suggest that the taxonomy may be useful to payers and to “provider
organizations considering ACO formation by accessing how their attributes match those of the
three clusters with regard to potential strengths and weaknesses for meeting the challenges
involved” with becoming an ACO (Shortell, Wu, Lewis, Colla, & Fisher, 2014).
Leavitt Partners also published a white paper proposing a taxonomy of accountable care
organizations. This report identifies six core types of ACOs: Independent Hospital and Hospital
12. 11
Alliance ACOs (both led by hospitals), Independent Physician Group, Physician Group Alliance,
and Expanded Physician Group ACOs (led by physician groups), and Full Spectrum Integrated
ACOs (led by integrated delivery systems) (Muhlestein, Gardner, Merrill, Petersen, & Tu, 2014).
They also identified two additional attributes can overlap with these six types: decentralized
decision maker ACOs which involves multiple organizations being involved in the ACO and
contributing to the decision-making structure and processes or previously unaffiliated
organizations joining to establish a new ACO and specialty ACOs that focus on a particular type
or group of patients such as a set of patients with a particular condition, illness, or disease
(Muhlestein, Gardner, Merrill, Petersen, & Tu, 2014, p. 6). They further advocated the value of
this type of information and analysis to ACOs, providers contemplating becoming an ACO,
suppliers who serve ACOs, and payers and policy makers that study and manage ACO contracts
(Muhlestein, Gardner, Merrill, Petersen, & Tu, 2014, p. 8).
Early expectations and early indicators of performance of ACOs
In the initial period after the passage of the ACA, opinions about the likely success of
ACOs in the context of health care reform ranged across a wide spectrum from strong negativity
to skepticism, to cautious optimism, to strong enthusiasm. The provisions of the ACA dealing
with ACOs did not escape a certain share of criticism and negative commentary. Certain
analysts with a critical bias have lamented the inadequacies of the concept of ACOs and
predicted their failure to accomplish their goals. Some critics doubted the model, some doubted
the government’s capacity to manage such a shift in care delivery with positive effect, and some
doubted that the concept could produce progress in cost reductions without concurrently
sacrificing quality and patient satisfaction. Early evidence suggests that this particular concern
13. 12
may not be supported based on surveys of the initial experience and perception of patients. One
initial study of patient satisfaction comparing baseline and comparative control data found that
“patients’ experiences were improved or preserved in provider organizations participating in
ACO programs despite incentives to limit health care use” (McWilliams, Landon, & Zaslavsky,
2014).
Some critics have argued that ACOs will face the same obstacles and the same fate as
these precedent attempts to change healthcare delivery and financing in the U.S. Shi & Singh
expressed the sentiment that ACOs “may well turn out to be nothing more than ‘old wine in new
bottles’” (Shi & Singh, 2015, p. 367). By this they suggest that ACOs may simply be another
manifestation of earlier failed attempts to control costs including through development of
integrated delivery systems (Burns & Pauly, 2012). Countering the premise of this criticism and
prediction of ACOs sharing the same fate as earlier attempts of managed care, Berwick contends
“the core of the ACO idea is coordinated care with free choice for beneficiaries. I think it’s a
brilliant idea… because it pulls one of the two fangs out of managed care: loss of choice. The
other fang is skimping, and that’s going to require strong monitoring of ACOs’ performance”
(Berwick, 2012, p. 722). Although the use of ACOs to transform the payment model of
Medicare and Medicaid is not a simple, easily implemented reform attempt and is not a panacea
for our serious health care financing challenges, they do hold promise for bringing about
significant savings and simultaneous improvement in quality of care and services provided
(Berwick D. , 2012). While the longer-term success of ACOs may still be uncertain, early
evidence and indicators show promising and hopeful results regarding the experience of patients
and the costs (Greene, 2015; McWilliams, Landon, & Zaslavsky, 2014).
14. 13
With the backdrop of these predictions and in the context of passionate ideological,
political, and legal confrontation, the experience and success of ACOs have varied over the past
two years. Casalino assesses “the performance of ACOs to date has been promising but not
overwhelming” (Casalino L. , 2014). Still he acknowledges that ACOs “represent the best
attempt to date to move away from business as usual toward health care that will improve
patients’ health and will not bankrupt the country” (Casalino L. , 2014). Despite the contention
and uncertainty surrounding health care reform and the effects of these particular reforms for the
long-term, broadly and fairly considered ACOs have demonstrated some early measured positive
results in patient satisfaction, health outcomes, and cost savings. In particular, one important
population of patients, medically complex patients, “reported significantly better overall care
after the start of ACO contracts” in one study (McWilliams, Landon, & Zaslavsky, 2014). In
discussing how ACOs have performed with regard to cost savings, Perez provides a detail
specific analysis of cost savings already achieved by ACOs. As demonstrated by the results of
Medicare Shared Savings Program (MSSP) ACOs, Pioneer ACOs, Medicaid ACOs, and
Commercial ACOs, results varied for individual ACOs related to cost savings while at a macro
level results broadly showed return on investment for ACOs as providers of care and significant
cost savings for payers. Once cost savings have reached specified goals, ACOs generally benefit
financially through revenue returned form shared-savings incentives (Perez, 2014).
Specific performance results of ACOs that are part of CMS programs, including the
MSSP, are publicized regularly. In late 2014 CMS reported:
Last year, many ACOs had higher quality and better patient experience than
published benchmarks. This year, compared to previous year performance, the
ACOs improved significantly for almost all of the quality and patient experience
measures demonstrating that these organizations improve care. ACOs in the
Pioneer ACO Model and Medicare Shared Shavings Program (Shared Savings
15. 14
Program) also generated over $417 million in savings for Medicare. At the same
time, ACOs qualified for shared savings payments of $460 million. (Center for
Medicare and Medicaid Services, 2014).
The process of reform and of changing the mechanisms, financing, and culture of health care
delivery and service will be slow to change. Even if criticism comes that the reforms and
changes in the system are not enough and even if it is too early to tell what the impact and import
of broader ACA and more precise ACO reform initiative will be, there is no question that the
demonstration projects and the activity around new ACOs, both commercial and public payer
related, are cause for innovation and hope. HHS, CMS, and the recently formed Center for
Medicare and Medicaid Innovation, have demonstrated skill at assessing, listening, adapting, and
revising policies, guidelines and regulations during the development and implantation of these
reforms and projects. In efforts to continue to nurture and encourage the development of ACOs
as a part of reforms to transform health care delivery and payment models, CMS announced and
sought public comment on several proposed adjustments intended to improve the Medicare
Shared Savings Program. The categories of these proposed adjustments were “providing more
flexibility for ACOs seeking to renew their participation in the program,” “encouraging ACOs to
take on greater performance-based risk and reward,” “emphasis on primary care,” “alternative
methodologies for benchmarks,” and “streamlining data sharing and reducing administrative
burden” (Center for Medicare and Medicaid Services, 2014). These proposed adjustments are a
positive sign of a allowing for nimbleness, flexibility and setting a tone to signal current and
future ACOs that there can be an open dynamic process for negotiating and adjusting the
payment and incentive models and sensitivity to the burden of the administrative and reporting
requirements of participating ACOs.
16. 15
Despite a climate of caution and uncertainty across much of the health care system over
the past several years, the growth in number of ACOs over the past several years has been
significant. According to one monitor of ACO growth and development the number of ACOs
increased from 82 in 2011 to 626 in the summer of 2014. This report breaks down this total in
the following way: “Of these 626 ACOs, 329 have government contracts, 210 have commercial
contracts, and 74 have both government and commercial contracts. The remaining 13 ACOs
have not made specific announcements about the nature of their accountable care contracts or are
in the process of finalizing contracts that are not yet active” (Petersen, Gardner, Tu, &
Muhlestein, 2014). This report notes that this growth in ACOs means that the total number of
“ACO-covered lives” as of June 2014 was approximately 20 million (Petersen, Gardner, Tu, &
Muhlestein, 2014).
Discussion of the potential and promise of ACOs
Analyzing the current state of health care reform implementation and the likely impact of
reforms on the healthcare system, a recent Robert Wood Johnson Foundation report asserts that
“more than any other policy change in the ACA, nothing has more potential to influence the
future of nearly every health care sector than Accountable Care Organizations (ACOs)” (2015
Accountable Care Organization Outlook: Implications for Suppliers and Providers, 2014).
From a broader analysis of the potential of ACOs to have a significant and positive role
in making progress toward the triple aims of increased quality, improved health outcomes, and
reduced costs, Perez concludes that “ACOs are an aggressive, innovative means of shifting the
business of health care from the well-entrenched fee-for-service model to a fee-for-value
17. 16
approach. They are an example of practicing the art of the possible, effecting fundamental
change in a large, capitalist society where the healthcare system is a complex web of public-and
private-sector involvement” (Perez, 2014). “If ACOs succeed, they will be a critical and lasting
legacy of the Affordable Care Act” (Casalino L. P., 2014).
Conclusion
Although there is still much uncertainty about the long-term meaning and significance of
the advent of accountable care organizations as alternate way of delivering and financing health
care, there is ample evidence that this phenomenon is growing and showing signs of sustainable
viability. Describing the promise and prospects of ACOs altering the framework and landscape
of health care delivery in the United States, DeVore & Champion made the following
observation several years ago:
ACOs represent a dramatic departure from the status quo of health care delivery.
They have the potential to overcome the fragmentation and volume orientation of
the fee-for-service system so that the right incentives are in place to foster health
and wellness, instead of payment for treating illness. Unlike previous efforts
under the “managed care” rubric that were mainly designed to reduce costs, a
properly designed ACO would balance that need against the need to improve
outcomes and improve the care experience. (DeVore & Champion, 2011).
Even with all the uncertainty and stress confronting health care providers over the past few years
with the implementation of the ACA, the hope and expectations of many health policy observers
regarding ACOs has remained high. Hopefully all the stakeholders involved in providing health
care in the U.S. can go forward with a spirit of cooperation and openness to working together to
improve the efficiency and the quality of health care in the U.S.
18. 17
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