Nicole Cafarella | April 29, 2011
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Washington, D.C.–Key provisions in the Affordable Care Act promise improvements in the quality of our nation’s health care at lower costs. This promise will take time, yet actually operating right now across America, hidden in plain sight, are initiatives in the private sector and state Medicaid programs that will change the way health care is delivered. The Affordable Care Act not only builds upon these efforts but also will significantly reinforce them.
Family doctors from North Carolina to California run primary care practices that are examples of the so-called “patient-centered medical homes” that the new health law encourages doctors to establish so patients can benefit from having one health care provider responsible for coordinating their care. Many of these medical homes date back to 1967 when the American Academy of Pediatrics first laid out standards for the earliest version of pediatric medical homes.
Similarly, state governments alongside private insurers and health care providers are exploring new ways of paying health care providers who would hold groups of providers jointly responsible for cost and quality in exchange for the opportunity to share in potential savings—like the accountable care organizations the Affordable Care Act encourages for Medicare patients. This is the kind of experience the new health law’s Center for Medicare and Medicaid Innovation will draw upon across the medical landscape to promote payment changes to encourage better quality care at lower costs.
To be sure, the new health law envisions it will take time and experimentation for these new ways for doctors and hospitals, clinics and medical specialists to coordinate care to take hold in earnest. Uncertainty about the future in large part explains why the Congressional Budget Office chose not to “score” (attribute cost savings to) these new medical practices in its analysis of the fiscal cost of the Affordable Care Act. But successful replications of these initiatives, when fully implemented in Medicare and
Medicaid and outside of the federal government, have the potential to double CBO’s estimated savings of the law over 10 years from $416 billion to $822 billion.
In this issue brief we will examine some of the existing operations that already for some Americans improve the quality and slow the cost growth of their health care. In the pages that follow, we will detail the existing and future benefits of:
- Patient-centered medical homes—primary care medical practices that act as hubs for coordinating patient care among multiple providers and provide comprehensive and accessible care to their patients
- Accountable care organizations—groups of health care providers that are held jointly accountable for quality and that share in savings for treating their patients at a lower cost
- The Center for Medicare and Medicaid Innovation, which will test, evaluate, and expand new and existing payment and health care delivery practices that are shown to reduce costs while maintaining or improving care quality.
What may not be well understood is that the Affordable Care Act’s cost-containment strategies were set in motion long before the passage of the Affordable Care Act—through activities that extend well beyond the Medicare program and that developed absent a national health reform law. The Affordable Care Act makes Medicare a partner in innovations already underway across the U.S. health care system—in the private sector and among state governments.
By making Medicare a participant in and supporter of these efforts, the Affordable Care Act presents an opportunity to align federal programs with efforts across the private sector and state governments—advancing cost-containment initiatives that result in the improved quality of care far beyond their current scope and breadth. For the full article, click here.
Download this issue brief (pdf) Read the brief in your web browser
Nicole Cafarella is the Payment Reform Project Manager and Policy Analyst with the Health Care team at the Center for American Progress.
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