Delivery System Reform: Making Health Care Work Better for Everyone

Summary: The Affordable Care Act gives us the tools to build a health care system that puts patients at the center.

In the six years since President Obama signed the Affordable Care Act, we’ve made important progress to bring more access to quality, affordable health care. Today, 20 million more Americans have insurance because of the ACA, bringing our uninsured rate to an all-time low. Since the ACA was enacted, health care prices have been rising at the slowest rate in five decades. And with new protections and benefits, everyone’s insurance provides preventive services at no extra cost, can’t cap coverage, and isn’t allowed to discriminate based on pre-existing conditions.

This progress has changed people’s lives, but it’s important to remember that the ACA has always been about more than affordable, quality coverage. It gives us the tools to build a health care system that puts patients at the center. Some people call this effort Delivery System Reform, but you could also just call it “making health care work better.”Watch this video to learn more:As the video explains, we’re doing three things to make this better system a reality.

1. Changing how we pay doctors and health care systems, so they can focus on quality not quantity.
2. Improving care, by encouraging better coordination and focusing on wellness and prevention.
3. Unlocking health care data and putting it to work.

We’ve made progress on this effort, and we are already starting to see the results of this work. Here are some of the initiatives happening today that are helping us create a system that provides better care, smarter spending, and healthier people.

Smarter Spending

• HHS set a goal of tying 30 percent of traditional, or fee-for-service, Medicare provider payments to quality through alternative payment models, such as Accountable Care Organizations (ACOs). We’ve already met the 30 percent goal. Go here for a quick overview of the Department’s alternative payment models.

• We’ve also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction programs.

• The Center for Medicare and Medicaid Innovation is working to find innovative ways to pay for quality rather than quantity. Some examples of this work include:
  • Comprehensive End Stage Renal Disease Care Model identifies and evaluates new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease.
  • Bundled Payments for Care Improvement Initiative is comprised of four models of care that link payments for multiple services that Medicare beneficiaries receive during an episode of care.
  • Comprehensive Care for Joint Replacement model holds hospitals accountable for the costs and quality of related care for the full episode of a hip or knee replacement from the time of the surgery through 90 days after hospital discharge.

• Accountable Care Organizations (what we call ACOs) are groups of doctors, hospitals and other health care providers who work together to give coordinated, high-quality care to their Medicare patients, and share in the savings they achieve. Some examples include Pioneer ACOs, the Medicare Shared Savings Program, Next Generation ACOs and the new ACO Investment Model.

• We recently announced a new test to find smarter ways to pay for drugs and improve quality in prescribing practices through drugs administered in doctor’s offices.

• The Health Care Payment Learning and Action Network is a collaboration among HHS, private payers, larger employers, health care providers, consumers, and state and federal partners to find common ground around smarter spending.

Improving Care

• CMS is also investing in initiatives designed to support clinicians in transforming and redesigning their practices to modernize and better care for their patients. See the Transforming Clinical Practice Initiative, the Comprehensive Primary Care Initiative, and the Federally Qualified Health Center Advance Primary Care Practice Demonstration (with the Health Resources and Services Administration).

• Partnership for Patients is a public-private partnership of doctors, nurses, hospitals, employers, patients and their advocates, and the federal and state governments to make care safer and improve the transition of care from one care setting to another, so that all hospital readmissions would be reduced.

• The Independence at Home Demonstration tests whether delivering primary care at home leads to better health outcomes for elderly patients with multiple chronic conditions, while actually reducing Medicare costs. The demonstration participants saved an average of $3,070 per participating beneficiary during the first year, while delivering high quality care at home.

• The Medicaid Innovation Accelerator Program is designed to build state capacity, improve care coordination in Medicaid, and provide support to states targeted to substance use disorders; complex health needs; long-term services and supports; and physical and mental health.

• Strong Start and Strong Start II are designed to determine if enhanced services in maternity care homes, group prenatal care, and birth centers for women enrolled in Medicaid or CHIP can reduce the rate of preterm births, improve the health outcomes of pregnant women and newborns and decrease the cost of medical care during pregnancy, delivery and over the first year of life.

Unlocking Health Care Data

• HHS rules improve the way electronic health information is shared and ultimately improve the way care is delivered and experienced. More information can be found on these efforts at HealthIT.gov.

• HHS brought together companies that provide 90 percent of electronic health records used by hospitals, health care systems with facilities in 46 states, and over a dozen professional associations and stakeholder groups on three core commitments that will help to make sure that health information works better for consumers and doctors.

• HHS has announced app challenges to make it easier for consumers to gather their health information from multiple systems and make health information more accessible and user-friendly for physicians.

• Physician Compare and Hospital Compare are websites that HHS has created to help consumers make informed choices about the health care they receive from Medicare physicians and other health care professionals. This includes 4,000 Medicare-certified hospitals across the country.

• • The Medicare Drug Spending Dashboard provides information on prescription drugs Medicare spending to provide additional information, increase transparency and address the affordability of prescription drugs.