Value-Based Care

January 2014 has arrived, and with that Affordable Care Act coverage begins. Over the next 12 months, the administration will thoroughly consider the ways in which it can control the rising costs of healthcare in the United States. This is especially true for the nation's Medicare program.

Starting in January, there will officially be an additional 123 accountable care organizations (ACOs) in the Medicare Shared Savings Program. As providers and hospitals transition to this emerging care model, there is mixed opinion over its longevity.

HHS announced the latest round of accountable care contracts in the Medicare Shared Savings Program, adding 123 additional ACOs and reaching about 1.5 million more Medicare beneficiaries.

Dr Peter Bach says professionals are looking at opportunities for new payment models and care redesign, but there are also threats that might surface. Each type of insurance payment model has different levels of risk factors. New payment models, such as the UHC pathways program and CMMI demo, have limited risk.

The Centers for Medicare & Medicaid Services announced Friday that it is seeking a second round of applicants to the Pioneer ACO Model. It is also soliciting suggestions for new accountable care organization models that encourage greater provider integration and financial accountability.

Accountable care organizations (ACOs) might have their year in 2014, if recent survey findings are suggestive of future trends.

City of New Orleans Health Commissioner Dr. Karen DeSalvo has been named as HHS' new national coordinator for health information technology. She starts Jan. 13.

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday.

David B. Hoyt, MD, FACS, executive director, American College of Surgeons (ACS), says their National Surgical Improvement Program is designed to help hospitals evaluate where they stand with certain complications, and to then help them through a series of techniques to improve the care around those complications.

PLAINSBORO, N.J. From leveraging their joint buying power to better deployment of a hard-to-find pediatric liver transplant surgeon, two large healthcare systems in Florida are seeing the benefits of sharing resources on a bigger scale, according to Kavita Patel, MD, of the Brookings Institution, and her co-authors who write in the inaugural issue of The American Journal of Accountable Care.

Access is an important component of the Triple Aim (cost, quality, access), and it has also been stressed as a significant factor in health reform initiatives. As the influx of uninsured increasingly seeks care, and if the number of providers available to provide primary care decreases as projected, achieving access to quality and cost-effective care may become more problematic.

The US health system has undergone notable transformations over the last 2 decades. Independent community hospitals haveconsolidated horizontally with others to form hospital healthcare systems, with many of the larger ones covering wide-ranging geographies, generating billions of dollars in operating revenues.

The Medicare, Medicaid, and Dual Eligibles programs are on the verge of a significant transition under the Affordable Care Act. Coordinating care and improving population health outcomes will require these federal programs to move away from outdated fee-for-service models to ones that incent better quality and more cost-effective delivery methods. At America's Health Insurance Plans (AHIP) Medicare, Medicaid, and Dual Eligibles conference held on September 23-26 in Washington, DC, the sessions featured discussions that highlighted the role health insurance plans will play as these federal programs continue to evolve under healthcare reform.

We are in the midst of exchange implementation-the centerpiece of the affordable care act-and it seems a good time to take stock of where we are and need to go. The ACA has validated and spurred on existing efforts. We are making progress on many fronts but fundamental changes are still needed to deliver on the promise of better value.

A young community health improvement collaborative in Trenton, New Jersey, is transforming healthcare for the community, with the community.

ACOs are entering into risk-based deals. Research suggests that many of these deals will have uncertain outcomes, which a new tool might help mitigate.

Hackensack Alliance ACO integrates pharmacists and adopts new technology as it joins in the bold experiment to lower costs and improve quality under health reform.

As accountable care organizations proliferate across the nation, delivery systems still struggle to balance quality improvement, cost containment, and migration toward accountable care. This paper describes the phased approach where the University of Florida Health Science Center and Shands Teaching Hospital and Clinics, Inc, and Orlando Health have jointly developed a series of clinical and health services that are of the highest quality and are offered at the lowest cost. The result is a regional collaborative that will be the foundation for a regional accountable care organization, first leveraging clinical core competencies, then moving to a more integrated model.

There is no question that the number of accountable care organizations in Medicare and total cost of care contracts in the private sector is growing, along with the amount of care provided under these contracts.

Almost half of 206 hospital executives polled in a recent survey said they do not intend to use an accountable care organization (ACO)-like model in their health systems. Only 20% of those polled currently participate in an ACO.

Thousands of hospitals, large and small, are girding for cuts to their Medicare payments in 2014, as federal pay-for-performance programs aimed at boosting clinical quality, improving patient experience and preventing unnecessary hospital readmissions roll into their second year.

The downward trend in preventable hospital readmissions that began in 2012 has continued well into this year, according to data published Friday on the CMS' blog. Quality experts were impressed but had questions.

A bicameral effort is quickly gaining traction in an effort that would forever change the sustainable growth rate (SGR) and Medicare reimbursement model.

Ora Pescovitz, MD, CEO of the Michigan Health System, says that academic medical centers like those at the University of Michigan are among those in the lead with patient-centered medical homes (PCMHs) and accountable care organizations (ACOs).