Issue brief examines health plan quality improvement efforts
Posted by Sara Rothenberg on July 29, 2014
In a new issue brief published by the Commonwealth Fund, researchers from Georgetown’s Center on Health Insurance reforms reviewed state action in selective contracting, informing consumers about health plan quality, and collecting data on insurers’ quality improvement efforts. The study found that 13 state-based marketplaces have taken action to implement the Affordable Care Act’s (ACA) quality improvement goals. The authors also assess technical and operational challenges states face in using the Marketplace to help drive system wide change in health care delivery.
Brookings proposes reforms to save hundreds of billions in health care
Posted by Nikki Hurt on April 30, 2013
The Brookings Institution recently released a study that indicates how value-based payments and small, conscientious quality improvements to both the private and public insurance sectors can significantly reduce health care costs in the future. Bending the Cure: Person-Centered Health Care Reform, describes how such changes could save the federal government $300 billion over the next 10 years and more than $1 trillion over the next 20 years. Brookings finds that moving to patient-centered care is the ultimate means by which future cost savings can be achieved. For a specific example, the study proposes that Medicare should move away from the fee-for-service model and embrace comprehensive payment organizations.
CMS issues proposed rule on regulatory burdens
Posted by Michal McDowell on February 5, 2013
Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule, which would reform Medicare regulations that CMS has identified as unnecessary, obsolete, or excessively burdensome on health care providers and suppliers, as well as certain regulations under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). The rule would enable health care professionals to devote resources to improving patient care through the elimination or improvement of requirements that currently impede quality or divert resources.
Update: Medicare Quality Measurement and Reporting Programs
Posted by Michal McDowell on September 19, 2012
A February 2011 Implementation Brief titled “Medicare Quality Measurement and Reporting Programs” addressed Congress’ continuing efforts through the Affordable Care Act (ACA) to transition the Medicare program from a traditional volume-based fee for service purchaser of health care items and services to a value-based purchaser. The ACA took significant steps to move beyond financial and other incentives for quality measure development, measurement, and reporting to financial and other incentives for actual improvements in care delivery (e.g., value-based purchasing). Since the initial 2011 brief, the Centers for Medicare and Medicaid Services (CMS) has made significant progress in implementing Congress’ vision. That progress is described below.
AF4Q brief reviews public reporting measures
Posted by Michal McDowell on August 7, 2012
Aligning Forces for Quality (AF4Q), the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of care in 16 targeted communities, has been a pioneer in collecting and publicly reporting data on the care provided by local physicians and hospitals. Measuring and publicly reporting on the quality and cost of care helps to improve quality and lower health care costs nationwide, and serves three important purposes: 1) it enables patients to make informed choices about their care and be better partners with their doctors; 2) it allows health care professionals to see where they can improve and motivates them to improve their performance; and 3) it allows consumers and purchasers to see the value they are getting for their money. Lessons and resources from AF4Q have been combined in a new brief that offers an overview on selecting performance metrics, engaging stakeholders, making performance reports consumer-friendly, and using performance measures to improve quality.
Administrative Simplification: Adoption of Operating Rules for Health Plan Eligibility and Health Care Claim Status Transactions
Posted by Mark Dorley on April 13, 2012
On July 8, 2011 the Secretary of the Department of Health and Human Services (HHS) issued an Interim Final Rule with Comment Period (IFR) regarding the operating rules for two types of HIPAA transactions: eligibility for a health plan and health care claim status. The rules are in response to Section 1104 of the Affordable Care Act (ACA), which directed the Secretary to adopt certain operating rules for transactions to enable electronic health information exchange and create greater uniformity in the transmission of health information.
The ACA defines operating rules as…
Health Affairs article finds Medicare’s pay-for-performance program did not spur quality improvement
Posted by Michal McDowell on April 11, 2012
Medicare’s flagship hospital pay-for-performance program, the Premier Hospital Quality Incentive Demonstration, began in 2003 but changed its incentive design in late 2006. The goals were to encourage greater quality improvement, particularly among lower-performing hospitals. However, the authors of a recent Health Affairs article found no evidence that the change achieved these goals. Although the program changes were intended to provide strong incentives for improvement to the lowest-performing hospitals, the authors found that in practice the new incentive design resulted in the strongest incentives for hospitals that had already achieved quality performance ratings just above the median for the entire group of participating hospitals. Yet during the course of the program, these hospitals improved no more than others. The findings in this article raise questions about whether pay-for-performance strategies that reward improvement can generate greater improvement among lower performing providers. They also cast some doubt on the extent to which hospitals respond to the specific structure of economic incentives in pay-for-performance programs.
Commonwealth Fund releases report with guidelines regarding quality improvement reporting
Posted by Michal McDowell on
A provision of the Affordable Care Act (ACA) requires health plans to submit reports each year demonstrating how they reward health care quality through market-based incentives in benefit design and provider reimbursement structures. By spring 2012, the U.S. Secretary of Health and Human Services (HHS) is expected to develop requirements for health plans to report on their efforts to: improve health outcomes, prevent hospital readmissions, ensure patient safety and reduce medical errors, and implement wellness and health promotion activities. Both employer group health plans, including self-insured plans, individual market plans, and qualified health plans sold through the insurance exchanges are required to submit such reports.
A report recently published by The Commonwealth Fund outlines key considerations…
RWJF and Urban Institute paper addresses patient-centered care in the ACA
Posted by Michal McDowell on March 12, 2012
The Robert Wood Johnson Foundation (RWJF) and Urban Institute recently released a paper examining the increased emphasis on a patient-centered care system under the Affordable Care Act (ACA). According to the Institute of Medicine (IOM), patient-centeredness means “care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” Through provisions requiring quality of care measurements, public reporting, and performance payments, the ACA reflects the movement toward patient-centered care. Although the ACA provisions are a significant milestone in the development of patient-centered health care delivery, rhetoric will need to be matched with funding for data collection, building consensus on measure use, and the integration, alignment, and harmonization of measures in different programs.
Update: Release of Medicare Data for Performance Measurement
Posted by Michal McDowell on February 24, 2012
Health policy experts and lawmakers believe that measuring and publicly reporting information about the performance of physicians, hospitals, and other health care providers is critical to improving health care quality and controlling costs. Advancing health information access and transparency is a goal of the Patient Protection and Affordable Care Act (ACA) , which includes a number of provisions to incentivize quality measurement and reporting and to enable more informed consumer decision-making. Across the country, community organizations, such as the Alliances participating in the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative, have been demonstrating the power of using private payer and Medicaid medical claims data to measure and publicly report on provider performance. Their work could be further strengthened by access to Medicare claims data because it is the single largest pool of information about how health care is delivered in America. Combining Medicare data with data from other public and private payers such as Medicaid and employer sponsored plans, holds the potential to generate more complete and accurate provider performance measurement information, thereby further empowering consumer engagement and quality improvement.