Delivery System Reform works to improve value relating to changes in care and payment models that reward increased quality, reduced costs, improved health of patients, and enhanced coordination of care. Reforming how care is delivered and paid for is at the heart of health care reform for all patients with a focus on complex populations.
California is one of 15 states awarded a federal contract to develop new models of coordinated care for people eligible for both Medicare and Medicaid, also known as “dual eligibles.” The state has about 1.15 million dual eligibles, who tend to have many chronic health conditions and rely on services from numerous providers. Currently, only a small portion of California’s dual eligibles are enrolled in organized health care systems.
The Kaiser Family Foundation released an online tool using 2010 American Community Survey data to help individuals estimate how much, if any, they will benefit from the new Medicaid eligibility rules and the new health insurance tax credit under the Affordable Care Act. Starting in 2014, most people who are uninsured or buying individual insurance with incomes up to four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012) will be eligible for expanded coverage through Medicaid or tax credits to subsidize the cost of private insurance.
On Feb 9, the CHA Board authorized creating a multidisciplinary statewide taskforce charged with developing policies, services, programs and information that will help hospitals transform for the future and guide CHA’s health care reform policy development. “We are at a critical point in time, and an intensive effort by a broad, high-level taskforce creates the best forum to assist hospitals with new and innovative ideas as they transform to meet future challenges,” said CHA Board Chair Steve Packer, MD, who has appointed the taskforce members.
The Congressional Budget Office (CBO) has released its budget forecast for fiscal year (FY) 2012 through FY 2022 in a report that projects a $1.079 trillion deficit for FY 2012. Key assumptions in the CBO projections include an increased cost of $54 billion for the Affordable Care Act (ACA) due to 1) the repeal of the CLASS Act (reducing $76 billion in premiums) and 2) correction of the modified adjusted gross income formula used to calculate Medicaid eligibility (the Medicaid “glitch”) netting revenue increases of $22 billion.
The Center for Medicare & Medicaid Innovation (CMMI) has released One Year of Innovation – a report summarizing the initiatives it has introduced involving providers of Medicare and Medicaid beneficiaries in all 50 states. Since its launch, CMMI has focused on improving patient safety, promoting care that is coordinated across health care settings, investing in primary care transformation, creating new bundled payments for care episodes, and meeting the complex needs of the dual-eligible population.
The Patient-Centered Outcomes Research Institute (PCORI) has released its first draft of national research priorities that includes five research areas: 1) comparative assessments of prevention, diagnosis and treatment options; 2) improving health care systems; 3) communication and dissemination; 4) addressing disparities; and 5) accelerating patient-centered and methodological research. PCORI was created to fund research that will offer clinicians and patients more information to support health care decisions.
The Centers for Medicare & Medicaid Services (CMS) Office of the Actuary has released a report on state health expenditures for 1991-2009. The findings reflect that in 2009, the 10 states with the highest per-capita spending spent 13 percent to 36 percent more than the national average, and the 10 states with the lowest per-capital spending spent 8 percent to 26 percent less than the national average.
The California HealthCare Foundation has issued the third report in a series that describes implications of the Affordable Care Act (ACA) and its expected impact on California’s health care delivery system. The report, Implementing National Health Reform in California: Payment and Delivery System Changes, focuses on reimbursement changes, ACA pilot programs, grants and other provisions designed to demonstrate alternative health care delivery and payment models. The report was prepared with information provided by federal and state officials, stakeholders and thought leaders.