Analysis & commentary: The foundation that health reform lays for improved payment, care coordination, and prevention

Health Affairs

Volumn 29, Issue 6, 2010, Pages 1183-1187

  Thorpe, Kenneth E ^a   Ogden, Lydia L ^b  

^a EMORY UNIVERSITY   (United States)

^b EMORY UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

COST CONTROL; GOVERNMENT REGULATION; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE FINANCING; HEALTH CARE ORGANIZATION; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH PROGRAM; HEALTH SERVICE; HOSPITAL COST; HOSPITAL READMISSION; INTEGRATED HEALTH CARE SYSTEM; MEDICAID; MEDICAL FEE; MEDICARE; NOTE; OBESITY; PHYSICIAN; PREVALENCE; PRIMARY MEDICAL CARE; PRIMARY PREVENTION; PROSPECTIVE PAYMENT; REIMBURSEMENT; UNITED STATES; ARTICLE; COST; LEGAL ASPECT; ORGANIZATION AND MANAGEMENT; PATIENT CARE; PREVENTIVE HEALTH SERVICE; STANDARD;

CONTINUITY OF PATIENT CARE; COST SHARING; DELIVERY OF HEALTH CARE, INTEGRATED; FEE-FOR-SERVICE PLANS; HEALTH CARE REFORM; HEALTH PLAN IMPLEMENTATION; PREVENTIVE HEALTH SERVICES; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 77956908151     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.0415     Document Type: Note

References (23)

1. The proportion of spending on chronic illness is estimated at 78 percent of private spending; 79 percent of Medicaid spending; and 98 percent of Medicare spending. Partnership for Solutions National Program Office. Chronic care: making the case for ongoing care: February 2010 update [Internet]. Baltimore (MD): Partnership for Solutions, Johns Hopkins University; 2010 Feb [cited 2010 Apr 29]. Available from: http://www.rwjf.org/pr/product.jsp?id=50968
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10. Projections assume that readmissions grow with inpatient hospital spending (2005-19), using the Congressional Budget Office's baseline projections. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy [Internet]. Washington (DC): MedPAC; 2007 Mar [cited 2010 Apr 29]. Available from: http://www.medpac.gov/documents/Mar07- EntireReport.pdf
11. The penalty can be expanded to all seven MedPAC-identified tracer conditions in fiscal year 2015. Medicare Payment Advisory Commission. Report to the Congress: promoting greater efficiency in Medicare [Internet]. Washington (DC): MedPAC; 2007 Jun [cited 2010 Apr 29]. Available from: http://www.medpac. gov/documents/jun07-EntireReport.pdf
12. As specified in the Patient Protection and Affordable Care Act, sec. 3023, the national pilot starts 1 January 2013 and runs for five years. A similar bundled-payment program for Medicaid is provided in sec. 2704 of the act. Medicare providers (such as hospitals) will receive a single Medicare severity diagnosis-related group (MS-DRG) payment as well as a payment for average spending (with some presumed savings built in) after discharge falling within the thirty-day window.
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15. Medicare beneficiaries and Medicaid enrollees (including children) with chronic conditions are eligible.
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18. Entitlement program changes are complemented by requirements in the Patient Protection and Affordable Care Act, sec. 2717, which stipulate that insurers must cover a comprehensive program for hospital discharge.
19. Enrollees with one chronic condition who are at risk of developing another (for example, people who are prediabetic or prehypertensive) are also eligible.
20. The legislation also provides $200 million in funds for small employers (those with 100 or fewer employees) for fiscal years 2011-15 to develop comprehensive workplace wellness programs.
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