What Should We Conclude From ‘ Mixed ’ Results In Payment Reform Evaluations?

Now that the Affordable Care Act (ACA) repeal-and-replace process is coming to an end, perhaps it’s a good time to turn to an area of health policy where there is considerably more bipartisan consensus: payment reform. Even here, however, challenges remain. A recent spate of evaluations, reviews, and published perspectives have cast doubt on the promise and spending-reduction potential of care coordination initiatives, shared savings accountable care organizations (ACOs), patient-centered medical homes, and bundled payments in particular. As the Trump administration, members of Congress, states, and other health care stakeholders formulate their own approaches to payment and delivery reform 3.0 (remember pay-for-performance?), it is important to avoid being overly discouraged in the face of the mixed results we have seen so far. Analyzing Payment Reform Results So Far Let’s start with the ACA’s flagship payment initiative, which was baked into the statute and thus not a Center for Medicare and Medicaid Innovation (the Innovation Center) pilot but a program, the shared savings ACOs or Medicare Shared Savings Program. It is an understatement to say that there is considerable disappointment that on balance the Shared Savings Program appears to be actually costing Medicare money, $216 million on net by the end of 2015. This means that the losers are losing more than the winners are saving for Medicare, net of their payouts. No downside risk for the Shared Savings Program AC...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Payment Policy Accountable Care Organizations Patient-Centered Medical Home Payment Reform Source Type: blogs