Research roundup: Accountable Care Organizations; Electronic health records; Medicaid and deficit reductions

Jan 7 2011

Health Affairs: Accountable Care Organizations: Making Them Work - The January issue of the journal features several articles examining initiatives underway that could help form ACOs, such as Blue Cross Blue Shield of Massachusetts' "Alternative Quality Contract,"a modified global payment model in which annual payments to medical groups are linked to a per member per month budget. The model was designed to improve quality and outcomes while greatly slowing health care spending growth." The authors write: "Models like the Alternative Quality Contract create stronger financial incentives for improving the value of care. By requiring that members have a primary care physician, they also give medical groups more ability to engage patients and coordinate care. … Barriers to success of the Alternative Quality Contract remain. Yet simply clinging to, or modestly rearranging, the fee-for-service payment systems of the past is not a viable option for long-term sustainability" (Chernew et al., 1/6).

Health Affairs: Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers - This analysis "proposes a more flexible payment model for providers and private insurers that would divide health care services into three categories: long-term, low-intensity primary care; unscheduled care, including unscheduled emergency services; and major clinical interventions that usually involve hospitalization or organized outpatient care. Each category of care would be paid for differently, with each containing different elements of financial risk for the providers." The author proposes that such a payment approach "would be modest, targeted, and flexible enough to accommodate both differences in readiness for health reform across US regions, and in the capacity of physicians and hospitals to reorganize care in the best interests of patients" (Goldsmith, 1/6).

American Journal of Managed Care: Electronic Health Record Adoption And Quality Improvement In US Hospitals - The authors found "mixed results" that "suggest that current practices for implementation and use of EHRs have had a limited effect on quality improvement in U.S. hospitals." For example, hospitals that had a "basic EHR" had better quality scores for treating heart failure but those that adopted "advanced EHR" showed decreased in quality scores for acute myocardial infarction, or heart attack, and heart failure (Jones et al., December 2010).

Kaiser Commission on Medicaid and the Uninsured: Comparison of Medicaid Provisions In Deficit-Reduction Proposals - "In response to mounting concern about the nation's rising debt and deficit prominent leaders and various commissions have come forward with recommendations to strengthen the economy and bolster the nation's fiscal health," according to this brief that highlights "key Medicaid changes that have been recommended as part of four broad-based deficit- and debt-reduction packages" - the Administration's National Commission on Fiscal Responsibility and Reform, the Debt Reduction Task Force, the Rivlin-Ryan Proposal and the Roadmap for America's Future. "The proposals vary dramatically in the depth and scope of Medicaid changes; however, some proposals would fundamentally alter the current structure and financing of the Medicaid program which could have significant implications for the populations served as well as states" (12/23).

Commonwealth Fund/National Academy for State Health Policy: State Strategies to Improve Quality and Efficiency: Making The Most Of Opportunities In National Health Reform - "States are key players in the implementation of national health care reform," according to this brief highlighting "initiatives from 10 states previously identified as leaders in using public-private partnerships to advance quality improvement, examining these states' anticipated challenges and perceived opportunities to use federal health reform to move forward." The information for the brief, which profiles efforts in Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington, was obtained through discussions with state representatives (Rosenthal, Gauthier and Arons, 12/23).

Health Affairs: Preventive Services Without Cost Sharing - "Improved access and reduced cost sharing for preventive services" in the federal health law will likely lead to a rise in the use of such services, and "[p]atients who formerly had been paying out of pocket for these services are likely to benefit," according to this policy brief that explores the potential benefits, costs and challenges likely to stem from this change. "The impact of greater use of preventive services is expected to grow over time, as the number of private health insurance plans that are considered grandfathered (and not subject to the coverage requirements) decreases" (Cassidy, 12/28).

Urban Institute: Why The Individual Mandate Matters - This brief examines what the removal of the individual mandate would mean for the federal health law, the Affordable Care Act (ACA), using a simulation model. With the mandate, "the number of insured would be cut by more than half but by only about 20 percent without the mandate ... Government spending on acute care for the nonelderly would increase by $69 billion under the ACA but would still rise by $50 billion under reform if the mandate were eliminated. ... This occurs because the government is still covering the less healthy uninsured without the mandate" (Buettgens, Garrett and Holahan, 12/20).