ACA changes on the way, CMS official says

We tend to focus on the Affordable Care Act as a law that simply gives more people health insurance – and it has.

But as we’ve noted before, the health reform law also contains all sorts of programs and provisions that aim to change how health care is delivered: how we pay, what we pay for, and how we shift from a hospital-centric acute care system to one that stresses prevention, wellness and care and management of chronic diseases. Examples can be found across the country.

At a recent AHCJ webinar, Patrick Conway, M.D., deputy administrator of the Center for Medicare and Medicaid Services, gave an overview of some of the changes underway. Conway, whose job includes oversight of the Center for Medicare and Medicaid Innovation, also announced the next big thing in Accountable Care Organizations. More on that below.

Patrick Conway, M.D.

His PowerPoint presentation is available on the AHCJ website (for at least the next six months) so there’s no point in repeating it all here. But it is worth noting some of his key points:

  • Innovation should be patient-centered.
  • Value, not volume, should be rewarded (including, to an extent, within the fee-for-service system).
  • CMS is stepping up efforts to shift to value-based payment. (See also this January announcement by HHS.)
  • Changing the health care system requires collaboration between government and private payers, and between the federal government and the state
  • Medicare per-capita spending growth is at historic lows.
  • Several new payment models are beginning to show measurable results.
  • Medicare hospital 30-day readmissions are declining.

CMS also has invested in innovation across the country, and is setting up a health care learning network to enable the spread of innovation.

A highlight of the webinar (and thank you for making news at an AHCJ event, Dr. Conway) was announcement of what he called “the next generation of ACOs,” along with the Pioneers and the Medicare Shared Savings Program (MSSP).

The “Next Gen” model has the ACO assuming more of the financial risk – and potentially reaping more of the reward. There also will be new tools to support patient engagement and care management. These ACOs will be able to cover skilled nursing care without a prior hospitalization, and offer more telemedicine and home health services. They also can reduce copays to encourage certain kinds of care. CMS expects about 15 to 20 ACOs to participate initially.

Several reporters who listened to the webcast went on to write about the Next Gen program. Among them were Bruce Japson in Forbes, Joyce Frieden in Medpage Today and Melanie Evans in Modern Healthcare. For McKnight’s, Elizabeth Leis Newman looked at the impact on nursing homes and other post-acute care.

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