As a strategy to improve Americans’ health status and reduce healthcare costs, the Affordable Care Act (ACA) allows employers to place up to 30% of total health insurance spending “at risk” for employees. Employees can keep/earn that share by participating in programs to reduce chronic disease risk factors and/or by controlling their cholesterol, blood pressure, and body mass indexes (BMI). Partly as a result of this provision, chronic disease risk factors have become a primary focus of many if not most major employers in America. Whether these wellness programs have worked is beyond the scope of this posting, but is unresolved. In 2010 Health Affairs published an oft-cited (albeit challenged and undefended) meta-analysis finding savings with these programs. This conclusion was directionally confirmed (except for randomized control trials, which showed a negative return on investment) by a 2014 meta-analysis in a wellness trade journal. Conversely, the Incidental Economist published several pieces on the questionable finances and other concerns raised by these programs. The Bloomberg BNA Healthcare Policy Report published a concise summary of the “con” argument. A 2014 RAND study of PepsiCo found no savings.
Obama’s claim the Affordable Care Act was a ‘major reason’ in preventing 50,000 patient deaths – The Washington PostApril 2, 2015
as our colleagues at PolitiFact noted, in-patient deaths were already declining before the Affordable Care Act was implemented. The Centers for Disease Control and Prevention found a 60,000 decline in patient deaths in the decade before 2010. This is not quite the same statistic, but it indicates that before the ACA was passed into law, progress was already being made in reducing deaths from conditions acquired in hospitals.
But officials say there is also little question that the half-billion dollars in ACA funding sparked significantly greater cooperation among thousands of hospitals. On pressure ulcers and adverse drug reactions, “we already had practices that we knew had worked,” another official said, but the Partnership for Patients took it to the next level by involving thousands of hospitals in a concerted effort to promote those practices. The law also created the CMS Innovation Center, which tests new ideas at participating hospitals for delivering better service without increasing costs.
Surge in Newly Identified Diabetes Among Medicaid Patients in 2014 Within Medicaid Expansion States Under the Affordable Care ActMarch 24, 2015
The number of Medicaid-enrolled patients with newly identified diabetes increased by 23% (14,625 vs. 18,020 patients) in the 26 states (and District of Columbia) that expanded Medicaid compared with an increase of 0.4% (11,612 vs. 11,653 patients) in the 24 states that did not expand Medicaid during this period. Similar differences were observed in younger and older adults and for both men and women.
CONCLUSIONS This study suggests that in the states that expanded Medicaid under the ACA, an increased number of Medicaid patients with diabetes are being diagnosed and treated earlier. This could be anticipated to lead to better long-term outcomes.
A patchwork of experiments across the country are trying to better manage these cases. The Center for Health Care Strategies, a policy center in New Jersey, has documented such efforts in 26 states. Some are run by private insurers and health care providers, while others are part of broader state overhaul efforts. The federal government is supporting some, too, through its $10 billion Innovation Center, set up under the Affordable Care Act.
“Measurement fatigue is a real problem in hospitals,” said Scott Wallace, a visiting professor at Dartmouth’s Geisel School of Medicine. “But, to me, the only metric that matters is, did you get better?”
As of last year, 33 federal programs asked providers to submit data on 1,675 quality measures, according to a government count. State, local and private health plans use hundreds more.
This year, many of the federal pay-for-performance programs carry financial penalties. Hospitals and doctors stand to lose millions in Medicare payments for missing filing deadlines or improvement benchmarks in programs that track hospital-acquired infections, readmissions and electronic-record use.
In all, about 80% of traditional Medicare spending is already tied to such pay-for-performance programs. HHS Secretary Sylvia Burwell said Monday the agency wants that to increase to 90% by 2018. She also set a goal of having 50% of Medicare spending in alternative payment models, in which providers are accountable for quality and the cost of care for groups of patients.
Surprisingly, despite the Medicare Advantage program’s widespread popularity and measurable success for both patients and taxpayers, Congress has repeatedly gone after this vital program with cuts that threaten its integrity and long term sustainability. Ultimately, bolstering Medicare Advantage in order to support innovative care coordination, quality patient outcomes and lower healthcare costs is a vital step for patients everywhere.
Health-information exchanges — not to be confused with health-insurance exchanges for purchasing coverage — are networks that allow patients’ records to be shared digitally among the providers caring for them. Through an HIE, emergency physicians could quickly access the medical history of a comatose accident victim, for example, or a specialist could review past test results and avoid ordering duplicates.
In 2009, the federal government allocated nearly $550 million in fiscal-stimulus funds to spur the development of HIEs in every state. More than 300 are in operation, including some run by state governments, some formed by hospital systems that share data only among their own affiliates and some public-private hybrids.
But dozens of HIEs have closed or consolidated amid funding and logistical woes, and experts say many more could struggle when federal funding ends this year. Previous efforts to create a statewide health-data network for California have foundered, though the state has some regional and local exchanges.