Future scan: Issues Affecting the Health Care System
This week’s readings touched on numerous issues affecting the health care industry now and in the future. Which of these issues has the potential to impact you either professionally or personally? Which of these issues are of particular concern and interest in your career as a health care administrator?
To Prepare for This Discussion:
This week, you examined the many potential issues and changes that can affect the health care system. Based on the knowledge you have gained throughout this course, consider what you think to be the most important or pertinent health care policy issue affecting the health care industry today. How might this issue improve health care costs? How might it transform the way health care is delivered? How might it change the way people access health care in the future? Think of an issue that has both current and future implications.
For example, in your Learning Resources this week, you read an article in Modern Healthcare, which outlines plans the CMS Innovation Center has for testing a next generation Accountable Care Organizations (ACO) model in 2016. In this model, “patients will be able to voluntarily enroll in accountable care and in exchange, have their co-pays reduced or eliminated for some services, such as primary-care visits” (Evans, XXXXXXXXXXThis articles offers a good example of current trends affecting relevant health care issues such as cost and access to care.
Based on insights you have gained throughout this course and the Learning Resources from this week, explain what you think is the most pertinent health care policy issue with the potential to transform the way health care is delivered. Then, provide a rationale for implementation of a policy brief from a legal, ethical, and operational perspective. Be specific and provide examples.
Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.
This week learning resources Article
CMS preps 'next generation' ACO model
ByMelanie Evans|March 10, 2015
The CMS Innovation Center unveiled plans for a new test of accountable care with greater financial risk for hospitals and doctors but also more freedom to influence how patients seek medical care.
The new program would launch in January 2016 and expand the following year to reach a total of 15 to 20 accountable care organizations, the CMS' Dr. Patrick Conway said during an Association of Health Care Journalists event Tuesday. Conway is the CMS deputy administrator for innovation and quality and its chief medical officer. The model—named by the Innovation Center as the“next generation ACO model”—will pay ACOs using a combination of capitation and fee-for-service. One option within the model will be almost full risk, Conway said.
In a significant departure from Medicare's existing ACO programs—the Shared Savings Program and the Innovation Center's Pioneer model—patients will be able to voluntarily enroll in accountable care and in exchange, have their co-pays reduced or eliminated for some services, such as primary-care visits, Conway said.
As in the current ACO programs, hospitals and doctors that successfully reduce the cost of care may keep some of the savings. But the “next generation” contracts will use a new formula to calculate savings targets that won't exclusively rely on ACOs' historical performance—an approach that some critics say is unfair to providers already delivering low-cost care.
The changes seek to address critics of Medicare's three-year-old foray into accountable care launched under the Affordable Care Act. Federal health officials have aggressively expanded Medicare's use of the model, and in January pledged to meetambitious targets through 2018for more widespread use of ACOs and other new payment models.
“This model is part of our larger effort to set clear, measurable goals and a timeline to move the Medicare program—and the healthcare system at large—toward paying providers based on the quality, rather than the quantity of care they give patients," HHS Secretary Sylvia Mathews Burwell said in a news release announcing the next generation ACO model.
Many ACOs havebalked at taking on greater riskunder Medicare's Shared Savings Program. Indeed, federal officials recently proposed allowing the program's participating networks to remain an additional three years (a total of six) under contracts that award bonuses without the risk of incurring penalties for failing to meet targets.
TheShared Savings Programis Medicare's largest test of accountable care, generating more than 400 ACOs since its launch in 2012. The Innovation Center separately operates a small ACO test known as Pioneers, which also launched in 2012 but agreed to more sophisticated and risky payment models. The number of ACOs in the Pioneer model hasdeclined from 32 to 19as hospitals and medical groups have struggled with the initiative's rules and risks.
Both programs have yielded mixed results so far. Participating providers saved $417 million for Medicare and earned bonuses totaling $460 million through the end of 2013, according to the CMS. That tally excludes first-year results for Pioneer ACOs. However, most of them did not perform well enough on cost targets to earn any bonuses.
The next generation contracts' new benefit design would seek to address what ACO officials have called a limited ability to engage patients in previous ACOs, Conway said. And, new savings target formulas will potentially benefit ACOs that would have struggled to achieve savings because of historically lower costs.
Conway suggested that the new model might be appealing to some of the Pioneers, as well as to hospitals and medical groups with patients in Medicare managed care.
Medicare patients have so far been assigned to accountable care organizations but have not enrolled. Some Pioneers have started atest to recruit patientsto see if they are more likely to seek care within the new ACO model, which may allow doctors to better manage cost and quality. ACO leaders say they have struggled to control patients' medical costs without approaches to benefit design and networks that are more common in managed care. However, Conway said patients who enroll in the new version of an ACO will continue to have the choice of seeking care from doctors or hospitals outside the ACO.
The CMS will accept applications for the first round of next generation ACOs through June 1.