Building regulatory and operational flexibility into accountable care organizations and 'shared savings'

Health Affairs

Volumn 30, Issue 1, 2011, Pages 23-31

  Lieberman, Steven M ^a   Bertko, John M ^b  

^a BROOKINGS INSTITUTION   (United States)

^b Engelberg Center for Health Care Reform   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

PRESCRIPTION DRUG;

ACCOUNTABLE CARE ORGANIZATION; ACT; CAPITATION FEE; COST BENEFIT ANALYSIS; FINANCIAL MANAGEMENT; HEALTH CARE COST; HEALTH CARE MANAGEMENT; HEALTH CARE ORGANIZATION; HEALTH CARE PERSONNEL; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH PROGRAM; HEALTH PROMOTION; HEALTH SERVICE; HUMAN; LEADERSHIP; MEDICARE; PROSPECTIVE PAYMENT; REVIEW; RISK MANAGEMENT;

COST SAVINGS; GOVERNMENT REGULATION; HUMANS; MEDICARE; PATIENT PROTECTION AND AFFORDABLE CARE ACT; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 79951656298     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.0928     Document Type: Review

References (10)

1. Shortell SM, Casalino LP, Fisher ES. How the Center for Medicare and Medicaid Innovation should test accountable care organizations. Health Aff (Millwood). 2010;29(7):1293-8.
2. The Social Security Act requires that most proposed Medicare regulations have a sixty-day public comment period. Once comments have been incorporated into a proposed regulation and a final rule has been published, the rule cannot become effective until thirty days after publication.
3. McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health Aff (Millwood). 2010;9(5):982-90.
4. US Congressional Budget Office. The long-termbudget outlook [Internet]. Washington (DC): CBO; 2010 Jun [cited 2010 Sep 10]. Available from: http://cbo.gov/ftpdocs/115xx/doc11579/06-30-LTBO.pdf
5. Gottlieb DJ, Zhou W, Song Y, Andrews KG, Skinner JS, Sutherland JM. Prices don't drive regional Medicare spending variations. Health Aff (Millwood). 2010;29(3):537-43.
6. Centers for Medicare and Medicaid Services. Medicare program; proposed changes to the hospital inpatient prospective payment systems for acute care hospitals and the longterm care hospital prospective payment system and proposed fiscal year 2011 rates; effective date of provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation requirements for providers of inpatient psychiatric services for individuals under age 21 (proposed rule). Fed Regist. 2010;75(85):23851-4362.
7. Centers for Medicare and Medicaid Services. Medicare program; payment policies under the physician fee schedule and other revisions to Part B for CY 2011 (proposed rule). Fed Regist. 2010;75(133):40039-718.
8. Subregulatory guidance includes program instructions, manuals, memos, instructions, and procurement documents, such as the requests for proposals that govern the contracts that CMS enters into with private prescription drug plans.
9. CMS had just over a year after the December 2003 enactment of the statute authorizing Part D before drug plans started submitting the first parts of their bids. In that short period of time, CMS had to hire new staff, create new computer systems, and issue regulations and contracting rules. Areas that needed improvement during 2006 included the transition of drug benefits from Medicaid to Medicare for people participating in both programs, and informing beneficiaries about plan choices. Elderly beneficiaries had felt they could not get clear information about the different drug plans - a problem exacerbated by CMS's failure to turn down weak bids and reduce the number of participating plans.
10. For organizations willing to accept substantial financial risk (such as by moving from fee-for-service revenues to partial capitation) in the hope of achieving financial gain, CMS might require appropriate state approval, such as a "mini-Knox-Keene" license in California. State of California Department of Managed Health Care. Knox-Keene Health Care Service Plan Act of 1975 [Internet]. Sacramento (CA): The Department; 2010 Feb [cited 2010 Sep 8]. Available from: http://wpso.dmhc.ca.gov/regulations/10kkap/10kkap.htm