Great Deal! Get Instant $10 FREE in Account on First Order + 10% Cashback on Every Order Order Now

Learning From State and Local Health Care Reform Efforts Health care reform efforts are moving toward frameworks that reward providers for the quality of health care delivered rather than the current...

1 answer below »

Learning From State and Local Health Care Reform Efforts

Health care reform efforts are moving toward frameworks that reward providers for the quality of health care delivered rather than the current model, which is focused on quantity. This requires a realignment of how health care is currently reimbursed to providers. To help achieve better care, in 2015, the Obama administration created the Health Care Payment Learning and Action Network involving 2,800 payers, providers, employers, patients, states, and consumer groups to help achieve this goal, which is “to transform the nation’s health system to emphasize value over volume” (Centers for Medicare and Medicaid Services, 2015).

Note: To find current data on health care reform efforts, review the press release in the article, “Better, Smarter, Healthier: Health Care Payment Learning and Action Network Kick Off to Advance Value and Quality in Health Care.”

Considering what you read in this week’s Learning Resources, what insights can you gain from state and local health care reform efforts? Taking the perspective of a health care administrator, how do you think these efforts might inform health care policy reform at the federal level? Is it possible to translate local reform to larger federal reform?

The State to discuss is North Dakota


Describe two key lessons you can take away from state/local health care reform efforts. Explain how these lessons might inform health care policy changes taking place at the federal level, if at all. Next, explain one reform effort that is considered a benchmark at the local level that in some way reduces health care costs, improves quality, or increases access to health care. Provide the link to the article or website in your post.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Better, Smarter, Healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value

In a meeting with nearly two dozen leaders representing consumers, insurers, providers, and business leaders, Health and Human Services Secretary Sylvia M. Burwell today announced measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.

HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.

To make these goals scalable beyond Medicare, Secretary Burwell also announced the creation of a Health Care Payment Learning and Action Network. Through the Learning and Action Network, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs. HHS will intensify its work with states and private payers to support adoption of alternative payments models through their own aligned work, sometimes even exceeding the goals set for Medicare. The Network will hold its first meeting in March 2015, and more details will be announced in the near future.

“Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people. Today’s announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health care dollars more wisely,” Secretary Burwell said. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement.”

"We're all partners in this effort focused on a shared goal. Ultimately, this is about improving the health of each person by making the best use of our resources for patient good. We're on board, and we're committed to changing how we pay for and deliver care to achieve better health," Douglas E. Henley, M.D., executive vice president and chief executive officer of the American Academy of Family Physicians said.

“Advancing a patient-centered health system requires a fundamental transformation in how we pay for and deliver care. Today’s announcement by Secretary Burwell is a major step forward in achieving that goal,” AHIP President and CEO Karen Ignagni said. “Health plans have been on the forefront of implementing payment reforms in Medicare Advantage, Medicaid Managed Care, and in the commercial marketplace. We are excited to bring these experiences and innovations to this new collaboration.”

“Employers are increasingly taking steps to support the transition from payment based on volume to models of delivery and payment that promote value,” said Janet Marchibroda, Health Innovation Director and Executive Director of the CEO Council on Health and Innovation at the Bipartisan Policy Center. “There is considerable bipartisan support for moving away from fee for service toward alternative payment models that reward value, improve outcomes, and reduce costs. This transition requires action not only by the private sector, but also the public sector, which is why today’s announcement is significant.”

“Today’s announcement will be remembered as a pivotal and transformative moment in making our health care system more patient- and family-centered,” said Debra L. Ness, president of the National Partnership for Women & Families.“This kind of payment reform will drive fundamental changes in how care is delivered, making the health care system more responsive to those it serves and improving care coordination and communication among patients, families and providers. It will give patients and families the information, tools and supports they need to make better decisions, use their health care dollars wisely, and improve health outcomes.”

The Affordable Care Act created a number of new payment models that move the needle even further toward rewarding quality. These models include ACOs, primary care medical homes, and new models of bundling payments for episodes of care. In these alternative payment models, health care providers are accountable for the quality and cost of the care they deliver to patients. Providers have a financial incentive to coordinate care for their patients – who are therefore less likely to have duplicative or unnecessary x-rays, screenings and tests. An ACO, for example, is a group of doctors, hospitals and health care providers that work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. In addition, through the widespread use of health information technology, the health care data needed to track these efforts is now available.

Many health care providers today receive a payment for each individual service, such as a physician visit, surgery, or blood test, and it does not matter whether these services help – or harm – the patient. In other words, providers are paid based on the volume of care, rather than the value of care provided to patients. Today’s announcement would continue the shift toward paying providers for what works – whether it is something as complex as preventing or treating disease, or something as straightforward as making sure a patient has time to ask questions.

In 2011, Medicare made almost no payments to providers through alternative payment models, but today such payments represent approximately 20 percent of Medicare payments. The goals announced today represent a 50 percent increase by 2016. To put this in perspective, in 2014, Medicare fee-for-service payments were $362 billion.

HHS has already seen promising results on cost savings with alternative payment models, with combined total program savings of $417 million to Medicare due to existing ACO programs – HHS expects these models to continue the unprecedented slowdown in health care spending. Moreover, initiatives like the Partnership for Patients, ACOs, Quality Improvement Organizations, and others have helped reduce hospital readmissions in Medicare by nearly eight percent– translating into 150,000 fewer readmissions between January 2012 and December 2013 – and quality improvements have resulted in saving 50,000 lives and $12 billion in health spending from 2010 to 2013, according topreliminary estimates.

To read a new Perspectives piece in the New England Journal of Medicine from Secretary Burwell:

To read more about why this matters: XXXXXXXXXXhtml

To read a fact sheet about the goals and Learning and Action Network: XXXXXXXXXXhtml

To learn more about Better Care, Smarter Spending, and Healthier People: XXXXXXXXXXhtml

Participants in today’s meeting include:

· Kevin Cammarata, Executive Director, Benefits, Verizon

· Christine Cassel, President and Chief Executive Officer, National Quality Forum

· Tony Clapsis, Vice President, Caesars Entertainment Corporation

· Jack Cochran, Executive Director, The Permanente Federation

· Justine Handelman, Vice President Legislative and Regulatory Policy, Blue Cross Blue Shield Association

· Pamela French, Vice President, Compensation and Benefits, The Boeing Company

· Richard J. Gilfillan, President and CEO, Trinity Health

· Douglas E. Henley, Executive Vice President and Chief Executive Officer, American Academy of Family Physicians

· Karen Ignagni, President and Chief Executive Officer, America’s Health Insurance Plans

· Jo Ann Jenkins, Chief Executive Officer, AARP

· Mary Langowski, Executive Vice President for Strategy, Policy, & Market Development, CVS Health

· Stephen J. LeBlanc, Executive Vice President, Strategy and Network Relations, Dartmouth-Hitchcock

· Janet M. Marchibroda, Executive Director, CEO Council on Health and Innovation, Bipartisan Policy Center

· Patricia A. Maryland, President, Healthcare Operations and Chief Operating Officer, Ascension Health

· Richard Migliori, Executive Vice President, Medical Affairs and Chief Medical Officer, UnitedHealth Group

· Elizabeth Mitchell, President and Chief Executive Officer, Network for Regional Healthcare Improvement

· Debra L. Ness, President, National Partnership for Women & Families

· Samuel R. Nussbaum, Executive Vice President, Clinical Health Policy and Chief Medical Officer, Anthem, Inc.

· Stephen Ondra, Senior Vice President and Chief Medical Officer, Health Care Service Corporation

· Andrew D. Racine, Senior Vice President and Chief Medical Officer, Montefiore Medical Center

· Jaewon Ryu, Segment Vice President and President of Integrated Care Delivery, Humana Inc.

· Fran S. Soistman, Executive Vice President, Government Services, Aetna Inc.

· Maureen Swick, Representative, American Hospital Association

· Robert M. Wah, President, American Medical Association

Answered Same Day Apr 23, 2020


Ritika answered on Apr 25 2020
131 Votes
Running Head: ASSIGNMENT
ASSIGNMENT         3
Title of Assignment
Name of Student
Name of University
The North Dakota healthcare initiative provides healthcare to general public living in that community. The healthcare reform committee in North Dakota was established in order to focus on the study and challenges that this healthcare delivery system offered for monitoring and implementing federal Affordable Care Act. All kind of health related impact that the rural public had to face was included in it and this emergency service focused on catering to human needs ("Health Care Reform Review Committee | North Dakota Legislative Branch", 2018). The two major lessons that one gets to learn from the health reform efforts at North...

Answer To This Question Is Available To Download

Related Questions & Answers

More Questions »

Submit New Assignment

Copy and Paste Your Assignment Here