Last month, we listed the goals and success measurements. The two goals of the Affordable Care Act (ACA) were expanding health insurance and reforming the health care delivery system. The measurements of success of the ACA in achieving these goals were achieving access to health care, the cost of that health care, and if there was improved quality of that care. Last month dealt with expanding health insurance and achieving access to health care. In this article, we will look at the second goal to see where the ACA is on the road to the success of achieving this goal.
Goal 2. Reforming the health care delivery system – It has now been five years since the ACA was implemented and many believe the ACA tried to do too much, too quickly, but was one of the most aggressive efforts in history to address the health care delivery system
A. Changes in payment for health care (cost of health care)
- Incentives to reduce Medicare readmissions to hospitals
- Incentives to reduce hospital-acquired conditions
- Pay-for-value program for hospitals and physicians
- Bundled payments
B. Changes in organization of health care delivery
- Accountable Care Organizations – to form new organizations to take responsibility for cost and quality for a defined population of Medicare members
- Primary Care Transformation – several groups of providers combine to try innovative payment and delivery models
C. Changes in workforce policy
- Encourage primary care to treat Medicaid patients
- created National Health Service Corps to offer scholarships/loan forgiveness to young primary care physicians to practice in an underserved area (Congress has not approved the funds for this yet)
D. Changes in government to be more nimble and innovative.
- Creation of Center for Medicare and Medicaid Innovation (CMMI) within CMS – authorized to undertake experimental programs to increase quality without increasing cost or reducing costs without reducing quality (ex.: Partnership for Patients – working with 3,700 hospitals to decrease hospital-acquired conditions and Medicare readmits)
III. Where it stands at five years: summary
A. Considerable improvement in access to care
B. Slowdown in the rate of increase in health care spending
C. Premature about cost effects on quality but preliminary studies show a decrease in hospital-acquired conditions and a decrease in Medicare readmits
D. Law has intruded on American people’s individual freedoms by (ex.: mandate for insurance, payment of penalties, restriction of health care markets, etc)
So, as you can see, there are several positive aspects of the ACA, but the big problem is the cost and sustainability. How the new proposals will deal with all of this will remain to see. It reinforces the statement made previously that the health care system in the U.S. is a very complex problem.