DOCSLIB.ORG

Healthcare Revenue Cycle Management

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Healthcare Revenue Cycle Management RESEARCH AND REPORT BY $ $ $ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ HEALTHCARE$ $ $ REVENUE $ $ CYCLE MANAGEMENT TRENDS IN ALTERNATIVE PAYMENT MODEL ADOPTION 2016 1 Contents Executive Summary 3 Vendors Covered in this Report 4 Demographics 5 Most Critical Aspects of RCM 6 Alternative Payment Model Adoption Rates 9 Why not adopting? 11 Revenue Cycle Management Alphabet Soup 12 A Key to Understanding APMs Accountable Care Organization (ACO) Bundled Payments Capitation Comprehensive Primary Care (CPC) and CPC+ MACRA - MIPS and APMs Pay for Performance (P4P) Value-Based Purchasing (VBP) Alternative Payment Models 14 Alternative Payment Vendors Used 15 Recommendation Ratings 17 Deficiencies 18 Alternative Payment Vendors Considered 19 Impact of Value-Based Adoption 21 Outsourcing 25 Conclusion 27 2 Executive Summary Revenue cycle management (RCM) runs the show on the financial end of health care. RCM solutions come in all shapes and sizes from tracking patient data to appointment scheduling to insurance verification to coding...and beyond. A good RCM solution reduces time between service and payment-- and getting paid sooner is always a good thing-- while taking the load off of employees who have more important duties to perform. In this updated report from a similar study last year, providers shared their current opinions on what they believe the impact of alternative payment models for value-based care will be on their organizations, which areas of RCM they will most likely need to outsource, and what vendors they are considering (whether for the first time or in replacement of their current solution). Disclaimer: As alternative payment models for value-based care are being adopted at staggeringly slow rates (if at all), there are few providers who felt they could give informed recommendations or opinions on this subject. This Reaction Report is a quick look at what’s going on in this realm. The data reflects that-- take it how you will. Research & Analysis: Jeremy Bikman Chris Jensen Junior Analyst: Jordyn Crowley 3 VENDORS COVERED IN THIS REPORT Disclaimer: We understand there is an array of payers and vendors who help providers with their varying revenue cycle management needs. In an attempt to simplify the lan- guage as we make comparisons, we will be referring to all as “vendors” throughout the report. 4 DEMOGRAPHICS Our participants represent a broad spectrum of opinions and concerns in their varying roles. Each provides a different perspective that vendors need to consider when servicing their solutions. Different sizes of hospitals also have very different opinions, concerns, and needs from their RCM vendors. Participants by Title *Other = Assistant Administrator; Chief Nursing Officer; Comptroller; Deputy Director of Recovery; Manager of Applications & Integration; Physician; Regional Director of Risk, Compliance, Privacy Officer; RN Participants by Bed Size 5 MOST CRITICAL ASPECTS OF RCM With varying importance placed on each item of this list, one thing is clear: effective RCM operations are absolutely critical to the overall health of every single provider organization in the country. Most Critical Aspects of RCM 6 CRITICAL ASPECTS CONT. Critical Aspects by Bed Count When segmented by organization size and by role, the individual trends generally follow the overall figures in the previous graphs, with most important aspects of RCM displayed on the left and less important on the right. However, we see a few segments breaking rank. Hospitals between 50-100 beds are more evenly concerned about these items with some exceptions. Where it becomes a little more interesting is in the 501-1,000 bed size organizations; this group appears to have a reverse trend in comparison to the other care facility sizes, with “clinical and financial outcomes” peaking in this segment. This group appears to be more concerned with the weight of an eventual, but inescapable, shift to true value-based care. In other areas, “eligibility and benefits” is the hot button for ambulatory facilities as they operate like small businesses rather than hospitals. Where many hospitals operate with government subsidies, ambulatory facilities need consistent patient payment for care (i.e. insurance) in order to keep the doors open. 7 CRITICAL ASPECTS CONT. Critical Aspects by Title 8 ALTERNATIVE PAYMENT MODEL ADOPTION RATES One year ago, in 2015, our data to see that this perspective has not changed showed that 36% of hospitals reported that much as value-based care continues to pick up they were adopting alternative payment steam. Luckily, providers elaborate on these models; 61% said they were not yet adopting decisions as pertaining to their opinions of such a payment model, but they would be in value-based payment models in the sections the future; only 3% said they would not adopt below. alternative payment models. It’s interesting Alternative Payment Model Adoption (Year-by-Year) Will your organization adopt alternative payment models for value-based care? 9 PAYMENT MODEL ADOPTION CONT. Adoption Rates by Title This trend seems to fit what would are more likely to be confident in making the be expected: bigger hospitals are much change. What we find interesting is the percent more likely to have the resources to pull off of outpatient participants suggesting they a new payment model adoption than smaller will wade out into the murky waters of value- hospitals. This trend has stayed fairly constant based care, despite the significantly different when considering last year’s study as well; business models many of the facilities operate hospitals with less than 500 beds are likely to under compared to hospitals. be the slowest to adopt, and the large hospitals Adoption Plans by Bed Count 10 WHY NOT ADOPTING? Providers who indicated they would not be adopting a value-based payment model offered up a variety of explanations. Some were of the opinion that doctors would be paid less than ever before due to noncompliant patients; outcomes determined primarily by patient compliance could lead to physicians cherry-picking patients whose outcomes will show higher levels of value. One provider even called the value-based system “diabolical.”’ “[Alternative payment model] [o]utcomes are determined primarily by patient compliance and it is diabolical to blame doctors for this. Doctors should be paid on the basis of how much work they do (that is how every other professional is paid!), and not on the basis of patient compliance. Under this new model, physicians will start to cherry pick patients, and the sicker, less compliant patients will have no care.” One opinion worth mentioning spoke to the metrics used by different payers; with no standardized approach, quality as measured by national organizations might not accurately reflect local volumes and supply and demand metrics. “Metrics used by payers are not reflective of the true quality of services delivered. Payers have different metrics-- no standardized approach as a group of payers… Payers change metrics in short term.” 11 ALTERNATIVE PAYMENT MODEL ALPHABET SOUP A Key to Understanding APMs Knowing just how many options providers have when it comes to alternative payment models (APMs), and what types of payments each model covers, is critical in understanding the revenue cycle management decision-making process. Which payments are guaranteed and which ones rely on performance? Which payments depend solely on quality and which factor in quantity? The main APMs, according to the data at hand, are briefly explained in the section below. Accountable Care Organization (ACO) PARTIAL Capitation payments are used to Groups of health care providers, ranging from pay providers a fixed sum based on specific hospitals to individual doctors, come together services that a patient receives for a specified in Accountable Care Organizations (ACOs) to amount of time; unspecified services will be coordinate care and provide the best possible paid on a fee-for-service basis. quality of service. Medicare offers differing ACO programs to incentivize providers, but Comprehensive Primary Care (CPC) and participation is voluntary. CPC+ Bundled Payments The Comprehensive Primary Care (CPC) initiative is a four-year, multi-payer, According to the Bundled Payments for Care single-model initiative (ending December Improvement initiative, under the Affordable 2016) taking place in seven U.S. regions Care Act, payments for multiple services to encourage providers to support five provided in one episode of care are linked “comprehensive” care functions. CPC together. Bundled payments serve as a happy practices receive a monthly care management medium between fee-for-service billing and fee. capitation. This initiative encourages more accountability when dealing with preventable Comprehensive Primary Care Plus (CPC+) conditions and coordination across health is a CPC redesign, beginning January 2017 care providers. and planned to run for five years. CPC+ Capitation will support up to 20 regions and will offer two payment tracks with requirements FULL Capitation payments are used to that should offer greater flexibility to care pay providers a fixed sum per patient for a beneficiaries. Providers who participate in specified amount of time. Capitation rates CPC+ will be paid up incentives up front, but are typically determined on a per patient, will have to return their payments should per month basis (PMPM to use management performance not be up to par. jargon), and vary by local
Load more

Recommended publications
  • Bundled Payment Fact Sheet
    DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Communications FACT SHEET FOR IMMEDIATE RELEASE Contact: CMS Media Relations Group August 23, 2011 (202) 690-6145 Bundled Payments for Care Improvement Initiative OVERVIEW The Affordable Care Act provides a number of new tools and resources to help improve health care and lower costs for all Americans. Bundling payment for services that patients receive across a single episode of care, such as heart bypass surgery or a hip replacement, is one way to encourage doctors, hospitals and other health care providers to work together to better coordinate care for patients both when they are in the hospital and after they are discharged. Such initiatives can help improve health, improve the quality of care, and lower costs. The Centers for Medicare & Medicaid Services (CMS) is working in partnership with providers to develop models of bundling payments through the Bundled Payments initiative. On August 23, 2011, CMS invited providers to apply to help test and develop four different models of bundling payments. Through the Bundled Payments initiative, providers have great flexibility in selecting conditions to bundle, developing the health care delivery structure, and determining how payments will be allocated among participating providers. BACKGROUND Medicare currently makes separate payments to providers for the services they furnish to beneficiaries for a single illness or course of treatment, leading to fragmented care with minimal coordination across providers and health care settings. Payment is based on how much a provider does, not how well the provider does in treating the patient.
    [Show full text]
  • Payment Reform GLOSSARY Definitions and Explanations of the Terminology Used to Describe Methods of Paying for Healthcare Services
    The Payment Reform GLOSSARY Definitions and Explanations of the Terminology Used to Describe Methods of Paying for Healthcare Services First Edition INTRODUCTION There is growing national recognition that the The Payment Reform Glossary also provides current systems used to pay physicians, hospi­ descriptions of many of the most significant tals, and other healthcare providers fail to en­ payment reform models that have been pro­ courage the highest-quality, most affordable ap­ posed or implemented by public and private proaches to care delivery. However, there has payers. been little consensus as to how payment reforms should be structured to solve the problems in A unique feature of The Payment Reform Glos­ current payment systems without creating new sary is that explicit comparisons and contrasts and potentially worse problems in their place. among key concepts are provided in highlight­ ed sections of the Glossary. One of the barriers to reaching consensus on significant payment reforms has been the com­ The intense focus on payment reform across the plex and confusing array of terminology that has country means that concepts will be evolving rapid­ been used to describe different payment sys­ ly and new programs will be proposed and imple­ tems. It is difficult for stakeholders to determine mented almost continuously. New editions of The whether to support a proposal if they do not un­ Payment Reform Glossary will be issued regularly derstand the words and abbreviations used to to ensure that the content is as current as possi­ describe it, and it is difficult to reach agreement ble. when the same words are used by different peo­ Additions, corrections, and suggestions for ple to mean different things or when words are improvements to the content of The Payment perceived by some stakeholders to mean some­ Reform Glossary are welcome.
    [Show full text]
  • CSC Towards Coordinated Care: Healthcare Payment Reform
    TOWARDS COORDINATED CARE: HEALTHCARE PAYMENT REFORM Authors: Tom Enders, Jason Fortin, and Melissa Harmon “We’ve got to change how Introduction healthcare is delivered… so Ideas and proposals for healthcare payment reform represent a significant that doctors are being paid departure from today’s mix of flat fee, diagnosis-related group, per diem, and for the quality of care, not the percent of fee-schedule reimbursement toward a system that ties payments quantity of care. We’ve got to to high-quality, tightly coordinated care. We believe that healthcare quality improvement and cost containment will not occur without payment reform, but make information technology that the appetite for real reform in this area remains limited. In the near term we more effective. We’ve got to expect experimentation with varying alternatives that couple fee-for-service with have the medical system work new models of payment linked to results, and in the long term a generational in teams so that people don’t shift to a new structure for reimbursement. go through five different tests.” The purpose of this paper is to outline the underlying concepts behind payment — President Barack Obama, reform proposals, examine evidence of the impact of proposed payment models, July 22, 20091 and discuss how provider organizations should prepare to succeed with these new models. The Concepts Behind Payment Reform Central to the intent of payment reform is to move away from “piece-work” payments, which compensate providers for individual units of work and towards comprehensive payments that reward quality and health outcomes. The goal of these efforts is to slow the rate of healthcare cost inflation — some target the desired rate to be at the consumer price index (CPI) level.
    [Show full text]
  • Affordable Care Act and Value-Based Purchasing: What's at Stake For
    August, 2015 The Affordable Care Act and Value-Based Purchasing: What’s at Stake for Children with Medical Complexity? Introduction The Patient Protection and Affordable Care Act of 2010, also known as the “ACA,” prioritizes the expansion of insurance coverage, prevention and public health innovation, and improvements in the health care delivery infrastructure (“Public Law 111-148: Patient Protection and Affordable Care Act,” 2010). The “Triple Aim” approach to improving population health, reducing health care costs, and improving the individual experience of care is inherent in the ACA, which calls for greater alignment of health care quality, costs, and value, while also promoting population health (Berwick, Nolan, & Whittington, 2008). Central to improvements in health care quality and the containment of health care costs are performance-based payment and care delivery models that shift from a traditional fee-for-service model to a greater focus on increased quality and accountability with an emphasis on evaluating, reporting, rewarding excellence, and penalizing poor health care delivery (Centers for Medicare and Medicaid Services, 2012; Damberg et al., 2014; Keckley, Coughlin, & Gupta, 2011). In its application, the ACA has the potential to maximize the health and well-being of high-cost and high-need populations, such as children with medically complex conditions (Berry, Agrawal, Cohen, & Kuo, 2013), by increasing access to afford- able care, high quality care, and appropriate care over the life course. Children with medical complexity1
    [Show full text]
  • Value-Based Care – Are You Ready?
    Value-Based Care – Are You Ready? Authors: Raymond Chang, Senior Consultant and Evan King, Executive Vice President The U.S. Health Care landscape is shifting at an unprecedented pace. Since implementation of the Patient Protection and Affordable Care Act (ACA), reimbursement policies and methodologies have undergone significant changes alarming providers (i.e., hospitals, health systems, physicians, allied health and post-acute providers/professionals across the country). 2015 was especially remarkable due to significant policy changes in Medicare, setting in motion the move towards value-based care for all governmental and commercial payors. Key Policy Changes Early in 2015, the U.S. Department of Health & Human Services (HHS) announced a plan to move Medicare reimbursement from the traditional volume-based, fee -for-service (FFS) payment model to quality-based, value- based alternative payment models. Accountable Care Organizations (ACOs) and bundled payment arrangements began to emerge. HHS also established aggressive goals and timelines to tie traditional fee-for- service payments to hospital value-based purchasing and readmission reduction programs (85% in 2016 and 90% by 2018). At least 30% of the payments in 2016 and 50% by 2018 must flow through alternative payment models. On April 16, 2015 President Barack Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) law, ending the legacy Sustainable Growth Rate (SGR) for Medicare Part B physician payments. The new law includes multiple major policy changes (i.e., Medicare physician payment reform, permanent two-year CHIP extension, post-acute and inpatient hospital payment updates, and delay in Medicaid Disproportionate Share Hospital (DSH) payments). In order to incentivize effective outcome- based care practices, Medicare physician payment reform provides two tracks of reimbursement methods – Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM).
    [Show full text]
  • Pay for Performance in Health Care: Methods and Approaches
    Pay for Performance in Health Care: Methods and Approaches EDITED BY Jerry Cromwell, Michael G. Trisolini, Gregory C. Pope, Janet B. Mitchell, and Leslie M. Greenwald Pay for Performance in Health Care: Methods and Approaches Edited by Jerry Cromwell, Michael G. Trisolini, Gregory C. Pope, Janet B. Mitchell, and Leslie M. Greenwald March 2011 RTI Press ©2011 Research Triangle Institute. RTI International is The RTI Press mission is to disseminate a registered trademark and a trade name of Research information about RTI research, analytic Triangle Institute. The RTI logo is a registered tools, and technical expertise to a national trademark of Research Triangle Institute. and international audience. RTI Press publications are peer-reviewed by at least This work is distributed under the two independent substantive experts and terms of a Creative Commons one or more Press editors. Attribution-NonCommercial-NoDerivatives 4.0 license (CC BY-NC-ND), a copy of which is available at RTI International is an independent, https://creativecommons.org/licenses/by-nc-nd/4.0 nonprofit research institute dedicated /legalcode. to improving the human condition. We combine scientific rigor and technical Library of Congress Control Number: 2011921923 expertise in social and laboratory ISBN 978-1-934831-04-5 sciences, engineering, and international https://doi.org/10.3768/rtipress.2011.bk.0002.1103 development to deliver solutions to the www.rti.org/rtipress critical needs of clients worldwide. This publication is part of the RTI Press Book series. RTI International 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA [email protected] www.rti.org Contents Acknowledgments v Contributors vi Abbreviations and Acronyms vii Introduction 1 Janet B.
    [Show full text]
  • Payment and Delivery System Reform in Medicare 1
    REPORT Payment and Delivery February 2016 System Reform in Medicare A PRIMER ON MEDICAL HOMES, ACCOUNTABLE CARE ORGANIZATIONS, AND BUNDLED PAYMENTS Prepared by: Susan Baseman* Cristina Boccuti Marilyn Moon* Shannon Griffin Tania Dutta* Kaiser Family Foundation American Institutes for Research (*) ACA Affordable Care Act ACO Accountable Care Organization APCP Advanced Primary Care Practice BPCI Bundled Payment for Care Improvement CJR Comprehensive Care for Joint Replacement CMMI Center for Medicare and Medicaid Innovation CMS Centers for Medicare and Medicaid Services CPC Comprehensive Primary Care EHR Electronic Health Record FFS Fee-for-Service FQHC Federally Qualified Health Center IAH Independence at Home IRF Inpatient Rehabilitation Facility MACRA Medicare Access and CHIP Reauthorization Act MAPCP Multi-Payer Advanced Primary Care Practice MSSP Medicare Shared Savings Program MS-DRG Medicare Severity Diagnosis Related Groups OCM Oncology Care Model SNF Skilled Nursing Facility Introduction ............................................................................................................................... 1 Executive Summary ................................................................................................................... 2 Medical Homes, Accountable Care Organizations (ACOs), and Bundled Payments: Descriptions and Summary of Early Evidence ................................................................................................. 7 Medical Homes ................................................................................................................................................
    [Show full text]
  • Moving Towards Bundled Payment
    ISSUE BRIEF Moving Towards Bundled Payment Introduction The fee-for-service system of payment for health care n Model 2 includes the inpatient hospitalization, physician services is widely thought to be one of the major culprits and post-discharge services. Medicare will pay in driving up U.S. health care costs. This system not only participants their “expected” Medicare payments, less a encourages volume but rewards poor quality and provides negotiated discount. little incentive for care coordination. Bundled payment, n Model 3 includes only post-discharge services. where providers are reimbursed a set fee for an episode of Payments will be made as in Model 2. care, would break down current payment silos and reward n Model 4 includes the inpatient hospitalization, physician providers for improving the coordination, quality and efficiency and related readmission services. Medicare will pay of care. While evidence of the impact of bundled payment is participants a prospectively determined amount. limited to date, there is growing interest from both payers and providers in further developing and testing this model. Numerous organizations applied to participate in the BPCI, and final selections and target negotiations are in progress. Under the Patient Protection and Affordable Care Act (ACA), CMS elected to delay Model 1 because of too few the secretary of the Department of Health and Human applicants. In reviewing data and applications, CMS has Services (HHS) must establish a five-year, voluntary pilot identified 48 conditions for bundling that together represent bundling program beginning in 2013. The program is to about 70 percent of spending on episodes of care.
    [Show full text]
  • President Obama Signs Bill to Eliminate Medicare SGR Payment System
    President Obama Signs Bill to Eliminate Medicare SGR Payment System President Barack Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) into law on April 17, permanently repealing the Medicare sustainable growth rate (SGR) formula used to determine physician payment rates. Congress had previously patched the SGR formula 17 times over the last 15 years. The U.S. Senate passed the legislation on April 14 by a vote of 92-8. The same measure passed the U.S. House of Representatives by a bipartisan vote of 392-37 on March 26. MAY 2015 Key elements of the legislation include: Permanently repeals SGR mechanism Updates physician payments annually by 0.5 percent in each of the years 2015 through 2019 Supports movement to alternative payment models (APMs) Establishes a Merit-Based Incentive Payment System (MIPS) to streamline and improve three distinct current law incentive programs Extends the Children's Health Insurance Program (CHIP) by two years The bill is partially offset through a combination of increased payments from higher-income Medicare beneficiaries and payment reductions to various Medicare providers. Six amendments were introduced to amend the legislation, but failed to be adopted. Senate Republicans introduced three amendments: To strike the pay-go exemption that typically requires any spending increase be paid for by a tax increase or spending cuts elsewhere: This amendment would strike the provision allowing Congress to identify offsets for the bill after enactment, therefore requiring Congress to identify savings to fully offset the legislation. To repeal the individual mandate: This amendment would repeal Sections 1501 and 1502 and subsections (a), (b), (c), and (d) of section 10106 of the Patient Protection and Affordable Care Act, and apply and administer the Internal Revenue Code of 1986 as if such provisions and amendments had never been enacted.
    [Show full text]
  • Medicare's Bundled Payment Initiatives for Hospital‐Initiated
    Original Article Medicare’s Bundled Payment Initiatives for Hospital-Initiated Episodes: Evidence and Evolution CHRISTINE A. YEE,∗,†,‡ STEVEN D. PIZER,∗,‡ and AUSTIN FRAKT∗,‡,§ ∗Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System; †University of Maryland Baltimore County; ‡School of Public Health, Boston University; §T.H. Chan School of Public Health, Harvard University Policy Points: r Evidence suggests that bundled payment contracting can slow the growth of payer costs relative to fee-for-service contracting, although r bundled payment models may not reduce absolute costs. Bundled payments may be more effective than fee-for-service payments r in containing costs for certain medical conditions. For the most part, Medicare’s bundled payment initiatives have not been associated with a worsening of quality in terms of readmissions, emer- gency department use, and mortality. Some evidence suggests a wors- r ening of other quality measures for certain medical conditions. Bundled payment contracting involves trade-offs: Expanding a bundle’s scope and duration may better contain costs, but a more comprehensive bundle may be less attractive to providers, reducing their willingness to accept it as an alternative to fee-for-service payment. Context: Bundled payments have been promoted as an alternative to fee-for- service payments that can mitigate the incentives for service volume under the fee-for-service model. As Medicare has gained experience with bundled pay- ments, it has widened their scope and increased their duration. However, there have been few reviews of the empirical literature on the impact of Medicare’s bundled payment programs on cost, resource use, utilization, and quality.
    [Show full text]
  • Accountable Care Guide for Gynecologists
    The Accountable Care Guide For Gynecologists ACCOUNTABLE CARE GUIDE FOR GYNECOLOGISTS Preparing Gynecologists for the Approaching Accountable Care Era page 1 ©2015 Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, L.L.P. The Accountable Care Guide For Gynecologists page 2 ©2015 Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, L.L.P. The Accountable Care Guide For Gynecologists ACKNOWLEDGMENT This strategic guide involved input through participation by many thought leaders of the following sponsoring organizations who have come together to form the Toward Accountable Care Consortium and Initiative (“TAC”). This paper would not have been possible without the generous support of all TAC member organizations, including significant support from the North Carolina Medical Society, as well as a substantial grant from The Physicians Foundation. Special thanks to the North Carolina Academy of Family Physicians and North Carolina Society of Anesthesiologists, whose seminal ACO white papers are the underpinning of this Toolkit. We are grateful to Julian D. (Bo) Bobbitt, Jr. of the Smith Anderson law firm, for compiling the information in this non-technical “blueprint” format, to Heather Wilson of Wilson Accounting Services for research and drafting, and to the follow physicians for their expertise and input: Michael O’Keefe, MD, Cornerstone Health Care; Arthur Ollendorff, MD, MAHEC OB/ GYN Specialist; Edward Newton, MD, Brody School of Medicine at ECU; Michelle Langaker, DO, Campbell University School of Osteopathic Medicine; William Johnstone,
    [Show full text]
  • The Affordable Care Act's Payment and Delivery System Reforms
    The COMMONWEALTH FUND Realizing Health Reform’s Potential MAY 2015 The Affordable Care Act’s Payment and Delivery System Reforms: A Progress Report at Five Years The mission of The Melinda Abrams, Rachel Nuzum, Mark Zezza, Jamie Ryan, Commonwealth Fund is to promote a high performance Jordan Kiszla, and Stuart Guterman health care system. The Fund carries out this mandate by Abstract supporting independent research In addition to its expansion and reform of health insurance cover- on health care issues and making age, the Affordable Care Act (ACA) contains numerous provisions intended to grants to improve health care resolve underlying problems in how health care is delivered and paid for in the practice and policy. Support for United States. These provisions focus on three broad areas: testing new delivery this research was provided by The models and spreading successful ones, encouraging the shift toward payment Commonwealth Fund. The views presented here are those of the based on the value of care provided, and developing resources for systemwide authors and not necessarily those improvement. This brief describes these reforms and, where possible, documents of The Commonwealth Fund or their initial impact at the ACA’s five-year mark. While it is still far too early to its directors, officers, or staff. offer any kind of definitive assessment of the law’s transformation-seeking re- forms, it is clear that the ACA has spurred activity in both the public and private sectors, and is contributing to momentum in states and localities across the U.S. to improve the value obtained for our health care dollars.
    [Show full text]