The Affordable Care Act Part VIII: Innovative Studies in Healthcare Solutions

[TexasTowelie]

By Dr. Brian Carr
President, Behavioral Health Associates, Lubbock, Texas, 1991-Present
Chairman, City of Lubbock Board of Health, 2013
Submitted on September 12, 2013 - 7:54am

Within the ACA are a series of non-binding studies that are intended to evaluate new methods of service delivery, management and payment for healthcare in the United States.

These studies are designed to move away from the traditional fee-for-service reimbursement model that is common today and explore other systems for how we can change the “sick care system” into a “health care system” where wellness is promoted and rewarded over waiting to fix a problem after it has exploded.

One study component of the ACA is looking at how a single lump-sum payment will be delivered to an organization such as a hospital, which will then hire a team of healthcare professionals to provide care to an individual patient for a specific health-related “episode” over a set period of time. An episode timeline could, for example, begin three days before hospitalization and end 30 days after discharge. The team might include professionals from the hospital, doctors in a physician group, members of a skilled nursing facility and caregivers in a home healthcare agency.

By conceptualizing the process of care in a more complete form the challenge to the hospital and healthcare team is to leave them with a goal to see that the patient is healed and not just moved through their system. For improved outcomes the treatment team members will receive increased financial rewards and patients benefit from a quicker recovery.

“Independence at Home” program

A team of health professionals deliver care to Medicare recipients in their own homes. If the members of the treatment team are able to prevent hospital readmissions, reduce costs and improve outcomes, while simultaneously achieving patient satisfaction, they will be given financial rewards.

Accountable Care Organizations (ACO)

In place of grouping people simply by their insurance carrier the concept of Accountable Care Organizations (ACO) clustered Medicare recipients so that they placed in a larger pool of health care professionals. ACOs with at least 5,000 Medicare recipients will be able to participate in this pilot study.

Hospitals, physicians, and home-care providers will work together to deliver comprehensive and continuous care to each patient that agrees to participate. Each member of the treatment team will be paid by the government on a FFS basis, with bonuses paid out for quality care that is delivered below a given dollar threshold.

ACOs will pool healthcare professionals for improved outcome via coordinated care in much the same manner that the exchanges pool individuals and businesses with insurance coverage.

Besides offering consumer protection and regulatory oversight of insurance carriers the ACA also includes a non-profit Patient Centered Outcomes Research Institute initiative. This research arm of the ACA will be used to participate in developing comparative effectiveness studies.

Bringing Health into a Sick Care System

The ACA includes a new initiative called the “National Prevention, Health Promotion and Public Health Council” which will help to manage the government’s efforts to promote personal wellness. This council will review the subject and issue reports on how to improve the overall health of the American people.

Recommendations thus far include:

· No co-pays for approved preventive tests including such things as mammograms and colonoscopies

· Approval of and support for employer-based programs that reward employees for personal wellness

· Nutritional labeling for food served in restaurants

· Increases spending in Medicaid for preventive services

· Prevention counseling in Medicare

Employer-Based Personal Wellness Reward Programs

· It lets an employer reduce the premiums, co-pays and deductibles of its employees who meet specific personal wellness thresholds

· Capped at 30 percent of the cost of the employee’s total coverage with an increase to 50 percent in 2014

Long term care

One of the greatest health care problems not well addressed in the current ACA model involves the care for those needing long-term skilled nursing care or for whom dementia has left them unable to function. About 10 million families in the US now have to deal with the challenges of long-term care and that number will grow as the population ages over the next 50 years.

Originally the ACA did provide a remedy for this problem. Community living assistance services and supports (CLASS) was designed to be insurance that would provide financial help for those who cannot complete basic living tasks (*such as feeding, dressing and bathing). It was intended to ease the heavy burden of assisted-living expenses for needy individuals and provide additional money so that they don’t have to rely only on Medicaid, private insurance and their family’s financial resources to make it. It was suspended in 2011 as being too extreme in cost.

If you have ever been involved in seeking care for a loved one with dementia or whose physical health status has declined to the point of needing round-the-clock nursing care then you know the financial and physical toll that this demands. As the ACA rolls out this area of healthcare will have to be revisited and solutions sought.

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http://lubbockonline.com/interact/blog-post/dr-brian-carr/2013-09-12/affordable-care-act-part-vii-innovative-studies

Cross-posted in Texas Group.

[font color=green]This is actually the eighth installment provided by Dr. Carr although the headline in the Lubbock Avalanche-Journal shows Part VII. [/font]

[area51]

1. ACA

aka GingrichCare, as this was completely a republican invention to force people to buy private, for-profit, lightly regulated insurance w/o a public option won't solve this nation's health care problems.

Just think of how many people's lives would be saved, and how there wouldn't be any medical bankruptcies, if we transitioned to single-payer.