Introduction
With the passage and subsequent continuing debate of the Affordable Care Act (ACA) in 2010 I believe 2011 will see a tremendous focus on several health insurance trends that will focus on increasing health insurance and employer purchasing value. These efforts in 2011 will focus on improving quality patient outcomes and increasing healthcare value. Healthcare now exceeds a staggering 17% of the American Gross National Product and yet the ACA largely ignores improving health care value in the individual and small group employer markets. Congress not only ignored a golden opportunity, they ignored tremendous evidence of HOW to increase health quality and value.
There are several means to increase health care value, WHILE simultaneously increasing quality. In fact they go hand in hand. These are:
- Accountable Care Organizations
- Wellness Programs
- Medical Home
- Lean Processes
Accountable Care Organizations
The term ACO was first described by Dr. Elliot Fisher, director of the Center for Health Policy Research at Dartmouth Medical School. Here's Dr. Elliot's definition:"ACOs consist of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth. Our definition emphasizes that these cost and quality improvements must achieve overall, per capita improvements in quality and cost, and that ACOs should have at least limited accountability for achieving these improvements while caring for a defined population of patients."
A Medicare oriented demonstration program was created within the PPACA to test a concept called an "Accountable Care Organization" model of health care delivery within the Medicare population.
Although the Medicare demonstration will be a limited program it will still provide extremely useful data on how care coordination and bonus payments to physicians and hospitals for good quality health outcomes can save the U.S. health system money.
The Affordable Care Act created a federal program operated by the Centers for Medicare and Medicaid Services (CMS) that pays bonuses to ACOs that keep costs under target thresholds and deliver care that meet quality standards. The Medicare Payment Advisory Commission recently recommended that CMS avoid adopting the bonus-only payment model and also fine ACOs that don't keep costs down. It is unclear whether the bonuses and fines would both be implemented at the start.
CMS Administrator Donald Berwick has indicated, according to Inside Health Policy, that CMS plans to implement a demonstration program to let accountable care organizations include Medicare beneficiaries and patients with private insurance. Specifically, he said the CMS innovation center will make room for the "vanguards" of accountable care organizations so CMS can test ACO models that go beyond what is called for under the ACO program.
This is just one of many new health care innovations that can ultimately lead to improved health care quality and also more efficient and less costly care down the road. Although the findings are a few years away, employers and agents can make a real impact by discussing and advocating for these types of changes that address the cost of health care itself. ACOs are just one element that is being tested to improve American health care value. Others are being explored as well.
