|July 7, 2010
12:01 AM EST
July Health Affairs: Roadmaps for the Unexplored Territory of Health Reform
Bethesda, MD -- The new health reform law charges the U.S. Department of Health and Human Services (HHS) with testing new payment and delivery models intended to improve health outcomes and restrain costs. But as the July issue of Health Affairs points out, implementing all of these activities will require a combination of flexibility, leadership, coordination, and political adroitness if reform is to succeed and stay on schedule.
An as yet untested, but potentially promising, aspect of health reform is stimulating the formation of new accountable care organizations (ACOs) in the Medicare program. The design of ACOs is a work in progress, but in essence, they would constitute a new way of paying for and delivering care to a group of patients at a sustainable cost. Stephen M. Shortell of the School of Public Health at the University of California, Berkeley, and his colleagues argue that ACOs could offer advantages to patients, providers, and payers. However, a key issue will be how to structure and implement the organizations so those potential benefits are maximized. That means structuring flexible models and payment approaches that are adapted to local needs and market conditions. The authors suggest that the government create three tiers of qualification criteria for ACOs, which would allow practices to assume greater risk and receive larger rewards over time. Such a system would also promote a more rapid diffusion of successful models nationally, they say.
ACOs are just one of several potentially promising payment models under consideration by the Centers for Medicaid and Medicare (CMS). In his analysis of proposed reforms, Jeff Goldsmith of Health Futures says there is probably no "silver bullet" to replace Medicare fee-for-service payment but notes that major reform models do allow for sharing of financial risk by hospitals or physicians, a critical factor in reducing Medicare expenses.
The establishment of a new Center for Medicare and Medicaid Innovation by 2011 will strengthen the CMS's authority and capacity to promote much-needed improvements in payment and service delivery, say Michael S. Barr, of the American College of Physicians, and colleagues. But the authors urge regulators to learn from the experience of the Medicare Health Support Program, a three-year experiment in improving chronic care. Lessons include the importance of strong leadership, receptivity of beneficiaries to care management, and having timely data about patients' status.
The success of the Patient Protection and Affordable Care Act depends on skillful and persistent implementation over the next few years by the administration, says Theda Skocpol of Harvard University. But she predicts that there will be many efforts by those opposed to reform to undermine it in various ways--including by reducing taxes or fees, loosening regulations on private insurers, and making health reform less generous to lower and middle-income Americans.
The Impact on Industry
The pharmaceutical and medical technology industries stand to gain from health reform and suffer relatively little pain, according to two analyses by leading industry experts.
Children and Insurance Coverage
Three studies call for policy changes to better serve children through Medicaid and the Children's Health Insurance Program (CHIP) as the country prepares to expand public health coverage to millions of uninsured Americans.
E-Health and Patient Care
How can online communication improve the patient-provider relationship and health outcomes? Two papers examine how e-mail, mobile phones, and other Internet-based technology can be better harnessed to deliver care.
Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at http://www.healthaffairs.org/. Address inquiries to Sue Ducat at (301) 841-9962 or firstname.lastname@example.org.