This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.
The notion of value is at once one of the most widely invoked and variably interpreted in American health care.
[cross-posted from the Health Cents blog on philly.com]
Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities
Early evidence suggests that accountable care organizations (ACOs) - networks of doctors and hospitals whose members share responsibility for providing coordinated care to patients - improve health care quality and constrain costs. ACOs are increasingly common in the U.S., both for Medicare and commercially insured patients. However, there are concerns that ACOs may worsen existing disparities in health care quality if disadvantaged patients have less access to physicians who participate in them. Does physicians’ ACO participation relate to the sociodemographic characteristics of their patient population, and if so, why?
Dr. Grace Terrell, President and CEO of Cornerstone Health Care, recently visited LDI and shared her experience of directing a physician-led health system through health care reform. Terrell, a primary care physician and a good Southern storyteller, told us about ‘Julia’, her patient of more than 20 years:
Much of what we hear about Accountable Care Organizations (ACOs) has to do with how well, or poorly, they’re serving the Medicare population. Medicare ACOs have received a great deal of attention, but less discussed is the application of this new health care delivery model to the Medicaid population.
Fifty years ago, on July 30, 1965, President Lyndon Johnson signed Medicare and Medicare into law. Over the next two years, more than 29 million people gained health coverage through these programs. By 1967, as Alice Rivlin recalls, economists were sounding an alarm about rising Medicare costs and reporting to the President that projected growth would be unsustainable.
As a recipient of the Alice Hersh Scholarship, I had the privilege of attending AcademyHealth’s 2015 National Health Policy Conference in Washington D.C. In addition to many interesting sessions, I had the opportunity to meet many leaders in the health care space, from health services researchers and policy makers to providers and business leaders.
As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This third post of a five-part series examines how new models of care delivery encouraged by reform will affect minority populations.
Abstract: Physician-to-physician referrals play a central role in the health care systems and are drives of costs and quality. There is evidence that referrals are currently misused and overused and recognition that they will have to change if health reform objectives such as care coordination and cost reduction are to be achieved (Son et al., 2014). Indeed, many of the models of care supported by the Affordable Care Act (e.g., accountable care organizations (ACOs), patient-centered medical homes, bundled payments) depend on physicians making high-value referrals.
The Affordable Care Act has generated carrots and sticks for hospitals to reduce readmissions. With the goal of achieving the Triple Aim (improving quality of patient care, improving population health, and reducing overall cost of care), innovative care delivery models are being tested locally and nationally, including the roll-out of Accountable Care Organizations and bundled payment programs. These programs create incentives in terms of shared savings for health care systems that provide high quality, coordinated care.
A few months ago, I spoke with LDI Senior Fellow Lawton R.
The news from the latest ACO study in JAMA seemed good; not only could ACOs save money in commercially insured patients in Massachusetts, the savings were "contagious," spreading to non-ACO Medicare patients seen by the same providers.