Transcript THE COMMONWEALTH FUND The Role of Payment Reform in Improving Health System Performance Stuart Guterman Vice President, and Executive Director, Commission on a High Performance Health System The.

THE
COMMONWEALTH
FUND
The Role of Payment Reform in
Improving Health System Performance
Stuart Guterman
Vice President, and Executive Director,
Commission on a High Performance Health System
The Commonwealth Fund
Society of American Business Editors and Writers
Business of Health Care Symposium
New York, NY
January 18, 2013
2
We have the most expensive
health care system in the world
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International Comparison of Spending on Health, 1980–2010
Average health spending
per capita ($US PPP)
Total health spending
as a percentage of GDP
18
9000
United States
Norway
Switzerland
Canada
Netherlands
Germany
France
Denmark
Australia
Sweden
United Kingdom
New Zealand
8000
7000
6000
5000
16
14
12
10
4000
8
3000
6
2000
4
1000
2
0
0
1980
1985
1990
1995
2000
2005
2010
United States
Switzerland
Canada
New Zealand
Sweden
Norway
1980
1985
1990
1995
France
Germany
Netherlands
Denmark
United Kingdom
Australia
2000
Notes: PPP = purchasing power parity; GDP = gross domestic product.
SOURCE: Commonwealth Fund, based on OECD Health Data 2012, available at http://stats.oecd.org/Index=aspx?DataSetCode=SHA.
2005
2010
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Total National Health Expenditures (NHE) 2011–2021:
Current Projection and Constant Proportion of GDP
NHE in trillions
$5.0
Current projection
Constant proportion of GDP
5.9% annual
growth;
77% over 10
years
$4.8T
(19.6% of GDP)
$4.4T
(17.9% of GDP)
$4.0
4.9% annual
growth;
62% over 10
years
$3.0
$2.0
$1.0
$2.7T
(17.9% of GDP)
NHE currently projected, 2012-2021: $36.8T
Total savings if NHE grows at same rate of GDP: $1.4T
$0.0
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Source: Commonwealth Fund CMS, Office of the Actuary, National Health Statistics Group, National Health Expenditure Projections
2011-2021, available at http://www.cms.hhs.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/Downloads/Proj2011PDF.pdf.
2021
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Rising health spending puts pressure on the
federal budget—but also on
state and local budgets, businesses, and
households
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Federal Health and Total Spending as a Percentage of GDP,
2000-2087
(Under CBO’s Extended Alternative Fiscal Scenario)
Percentage of GDP
35
30
25
20
15
10
5
Health spending
Total noninterest spending
0
2000
2010
2020
2030
2040
2050
2060
2070
2080
NOTE: Figures for 2012-2087 are projections; CBO’s extended alternative fiscal scenario assumes that Medicare payment rates for
physicians are maintained at the 2012 levels, the automatic spending reductions required by the Budget Control Act of 2011 do not
take effect, and after 2022 several policies that would restrain spending growth do not take effect; most other federal spending is
assumed to grow at the same rate as GDP after 2027.
SOURCE: Congressional Budget Office, Supplemental Data for The 2012 Long-Term Budget Outlook (Washington, DC:
Congressional Budget Office, June 2012), available at http://www.cbo.gov/sites/default/files/cbofiles/attachments/43288LTBOSuppTables_0.xls.
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Medicare Spending per Enrollee Projected to Increase More Slowly Than
Private Insurance Spending per Enrollee and GDP per Capita
Annual rate of growth (percent)
8.0
GDP per capita
7.0
6.0
Medicare spending per enrollee
Employer-sponsored insurance spending per enrollee
5.0
3.7
4.0
3.0
4.6
4.5
3.8
2.9
2.7
2.0
1.0
0.0
2008–2011
2011–2021 (projected)
Note: GDP = gross domestic product.
Source: CMS Office of the Actuary, National Health Expenditure Projections, 2011–2021, updated June 2012.
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Projected U.S. National Health Expenditures (NHE) by Source,
2013–2023
NHE in $ billions
6000
$5.5 trillion
Federal
government
5000
$4.0 trillion
32%
State and local
government
4000
$2.9 trillion
31%
28%
18%
3000
2000
18%
24%
18%
25%
1000
26%
26%
28%
26%
2013
2018
2023
17.9%
18.7%
20.5%
Private employers
(including "other
private revenue")
Households
0
% GDP:
Note: GDP = gross domestic product.
Source: Estimates by Actuarial Research Corporation for The Commonwealth Fund.
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Premiums Rising Faster Than Inflation and Wages
Cumulative changes in insurance
premiums and workers’ earnings,
1999–2012
Projected average family premium as a
percentage of median family income,
2013–2021
Percent
Percent
200
Health insurance premiums
175
180%
Workers' contribution to premiums
150
Workers' earnings
125
Overall inflation
35
30
172%
25
22 23
20
100
15 12 13
75
50
25
47%
10
38%
5
15
17
18 18 18 18
19
24
26
25 26
27
28 29
30
31
20
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
0
0
Projected
Sources: (left) Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits Annual
Surveys, 1999–2012; (right) Commonwealth Fund estimates based on CPS ASEC 2001–12, Kaiser/HRET 2001–12,
CMS OACT 2012–21.
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The system’s performance doesn’t match the
level or trend in spending
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Rating of U.S. Health System’s Performance
“On the whole, how successful is the U.S. health system in achieving high performance on the following domains?”
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Source: Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, Aug. 2011.
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How the U.S. Health System Scores on
Dimensions of a High Performance Health System
2006 revised
2008 revised
2011
75
73
70
Healthy Lives
70
71
Quality
75
*
67
Access
57
55
52
53
53
Efficiency
*
Equity
69
71
69
67
65
64
OVERALL SCORE
0
* Note: Includes indicator(s) not available in earlier years.
Source: Commonwealth Fund Commission on a High Performance Health System. Why Not the Best? Results
from the National Scorecard on U.S. Health System Performance, 2011 (New York: The Commonwealth Fund,
October 2011)
100
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2010: 29 Million Adults Under Age 65 Underinsured,
81 Million Either Underinsured or Uninsured
Uninsured
during year
45.5 million
(26%)
Insured, not
underinsured
110.9 million
(65%)
Uninsured
during year
52 million
(28%)
13
Insured, not
underinsured
102 million
(56%)
Underinsured*
29 million
(16%)
Underinsured*
15.6 million
(9%)
2003
2010
Adults 19–64
(172 million)
Adults 19–64
(184 million)
* Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or more of income;
medical expenses equaled 5% or more of income if low income (<200% of poverty); or deductibles equaled 5% or more of income.
Source: C. Schoen, M. Doty, R. Robertson, S. Collins, “Affordable Care Act Reforms Could Reduce the Number of Underinsured U.S.
Adults by 70 Percent,” Health Affairs, Sept. 2011. Data: 2003 and 2010 Commonwealth Fund Biennial Health Insurance Surveys.
Underinsured and Uninsured Adults at High Risk of
Going Without Needed Care and of Financial Stress
14
Percent of adults (ages 19–64)
Insured, not underinsured
75
Underinsured
Uninsured during year
63
52
46
50
28
58
27
25
0
Went without needed care because
of costs*
Have medical bill problem or
outstanding debt**
* Did not fill prescription; skipped recommended medical test, treatment, or follow-up; had a medical problem but did not visit doctor;
or did not get needed specialist care because of costs. ** Had problems paying medical bills; changed way of life to pay medical
bills; or contacted by a collection agency for inability to pay medical bills or medical debt.
Source: C. Schoen, M. Doty, R. Robertson, S. Collins, “Affordable Care Act Reforms Could Reduce the Number of Underinsured U.S.
Adults by 70 Percent,” Health Affairs, Sept. 2011. Data: 2003 and 2010 Commonwealth Fund Biennial Health Insurance Surveys.
Mortality Amenable to Health Care
Deaths per 100,000 population*
1997–98
150
2006–07
134
127
116
115
109
99
100
89
88
120
113
106
97
97
88
81
76
50
96
57
55
61
60
61
64
66
74
67
76
79
78
77
80
83
d
De
nm
Un
ar
ite
k
d
Ki
ng
do
Un
m
ite
d
St
at
es
al
an
d
Ze
la
n
Ne
w
Ir e
ec
e
Gr
e
m
an
y
d
Ge
r
Fi
nl
an
No
rw
ay
Ne
th
er
la
nd
s
Au
st
ria
en
Sw
ed
pa
n
Ja
ly
It a
ra
lia
Au
st
Fr
an
ce
0
* Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and
bacterial infections.
Source: Commonwealth Fund Commission on a High Performance Health System. Why Not the Best? Results from the
National Scorecard on U.S. Health System Performance, 2011 (New York: The Commonwealth Fund, October 2011)
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Quality of Care*
(1-Year Survival Index, Median=70%)
Quality and Costs of Care for Medicare Patients Hospitalized
for Heart Attacks, Hip Fractures, or Colon Cancer,
by Hospital Referral Regions, 2004
1.20
1.10
1.00
0.90
0.80
0.70
0.80
0.90
1.00
1.10
1.20
1.30
Relative Resource Use**
* Indexed to risk-adjusted 1-year survival rate (median=0.70).
** Risk-adjusted spending on hospital and physician services using standardized national prices.
Data: E. Fisher, J. Sutherland, and D. Radley, Dartmouth Medical School analysis of data from a 20% national sample of
Medicare beneficiaries.
Source: The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from
the National Scorecard on U.S. Health System Performance, 2008, (New York: The Commonwealth Fund, July 2008).
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What Drives Variation in Spending?
Average risk-adjusted standardized spending for chronic
obstructive pulmonary disease episode
Type of service
Low
Average
High
Difference between
high and average
%
$
Total episode
6372
7871
9748
23.8
1877
Initial hospital stay
4408
4414
4406
-0.2
-8
Physician
547
569
576
1.2
7
Readmissions
671
1543
2550
65.3
1007
Post-acute care
466
998
1780
78.4
782
Other
280
347
436
25.6
89
SOURCE: G. Hackbarth, R. Reischauer, and A. Mutti, "Collective Accountability for Medical Care—Toward Bundled Medicare
Source:
G. New
Hackbarth,
R. Reischauer,
“Collective Accountability for Medical Care—Toward Bundled
Payments,"
England Journal
of Medicineand
JulyA.
3, Mutti.
2008 359(1):3–5.
Medicare Payments” New England Journal of Medicine July 3, 2008 359(1):3-5.
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Receipt of Recommended Screening and
Preventive Care for Adults
Percent of adults age 18+ who received all recommended screening and
preventive care within a specific time frame given their age and sex*
U.S. Average
49
2002
50
2005
51
2008
U.S. Variation 2008
60
400% + of poverty
200% –399% of poverty
49
41
<200% of poverty
56
Insured all year
46
Uninsured part year
32
Uninsured all year
0
20
40
60
80
100
* Recommended care includes at least six key screening and preventive services: blood pressure, cholesterol, Pap,
mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot.
Source: Commonwealth Fund Commission on a High Performance Health System. Why Not the Best? Results from the
National Scorecard on U.S. Health System Performance, 2011 (New York: The Commonwealth Fund, October 2011)
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Access Problems: More Than Two of Three Adults
Have Difficulty Getting Timely Access to Their Doctor
19
Percent reporting that it is very difficult/difficult:
Getting an appointment with
a doctor the same or next day
when sick, without going to the
emergency room
29
Getting advice from your doctor by
phone during regular office hours
39
Getting care on nights, weekends,
or holidays without going to
the emergency room
58
71
Any of the above
0
25
50
75
Source: K. Stremikis, C. Schoen, and A.-K. Fryer, A Call for Change: The 2011 Commonwealth Fund Survey of
Public Views of the U.S. Health System (New York: The Commonwealth Fund, April 2011).
100
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Potential Waste and Inefficiency: More Than Half of Adults
Experience Wasteful and Poorly Organized Care
Percent reporting in past two years:
Doctors ordered a test
that had already been done
23
Time spent on paperwork
related to medical bills and
health insurance a problem
26
Health care system
poorly organized
36
54
Any of the above
0
25
50
Source: K. Stremikis, C. Schoen, and A.-K. Fryer, A Call for Change: The 2011 Commonwealth Fund Survey
of Public Views of the U.S. Health System (New York: The Commonwealth Fund, April 2011).
75
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Poor Coordination of Care Is Common,
Especially if Multiple Doctors Are Involved
Number of Doctors Seen
Percent reporting in past two years:
Any
1 to 2
3+
After medical test, no one called or wrote you about
results, or you had to call repeatedly to get results
27
21
36
Doctors failed to provide important information about
your medical history or test results to other doctors or
nurses you think should have it
23
22
26
Test results or medical records were not available at
the time of scheduled appointment
18
14
29
Your primary care physician did not receive a report
back from a specialist you saw
15
11
24
Your specialist did not receive basic medical
information from your primary care doctor
12
9
18
Any of the above
47
42
55
Source: K. Stremikis, C. Schoen, and A.-K. Fryer, A Call for Change: The Commonwealth Fund 2011 Survey of
Public Views of the U.S. Health System (New York: The Commonwealth Fund, April 2011).
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So what’s the problem with our system?
And how do we fix it?
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A Majority of Americans Say the Health Care System
Needs Fundamental Change or Complete Rebuilding
Only minor
changes needed
Fundamental
changes needed
Rebuild
completely
22
46
26
<$35,000
21
42
30
$35,000–$49,999
21
43
34
$50,000–$74,999
30
41
27
$75,000 or more
19
57
19
Insured all year
24
49
23
Uninsured during year
16
40
37
Northeast
17
46
31
North–Central
20
49
25
South
24
45
24
West
27
44
27
Percent reporting
Total
Annual income
Insurance status
U.S. region
Note: Subgroups may not sum to total due to rounding.
Source: K. Stremikis, C. Schoen, and A.-K. Fryer, A Call for Change: The 2011 Commonwealth Fund Survey of Public
Views of the U.S. Health System (New York: The Commonwealth Fund, April 2011).
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Support for More Accessible, Coordinated,
and Well-Informed Care
Total:
Very important
or important
Very
important
Important
You have one place/doctor responsible for
primary care and coordinating care
93
64
29
On nights and weekends, you have a place to
go besides ER
85
54
31
All your doctors have easy access to your
medical records
96
70
26
You have information about the
quality of care provided by different
doctors/hospitals
96
58
38
You have information about the costs of care
to you before you actually get care
89
58
31
Percent reporting it is
very important/important that:
Note: Subgroups may not sum to total due to rounding.
Source: K. Stremikis, C. Schoen, and A.-K. Fryer, A Call for Change: The Commonwealth Fund 2011 Survey of Public Views of the
U.S. Health System (New York: The Commonwealth Fund, April 2011).
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Support for Doctors Working in
Teams and Groups to Improve Patient Care
25
Percent reporting it is very important/important for improving patient care
100
Important
86
75
Very important
65
44
50
25
36
42
30
0
Doctors and nurses working closely as
teams, with expanded role for nurses
Doctors practicing with other doctors in
groups, rather than on their own
Note: Subgroups may not sum to total because of rounding.
Source: K. Stremikis, C. Schoen, and A.-K. Fryer, A Call for Change: The 2011 Commonwealth Fund Survey of
Public Views of the U.S. Health System (New York: The Commonwealth Fund, April 2011).
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The impact of health reform
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COMMONWEALTH
FUND
System Improvement Provisions in the
Affordable Care Act of 2010
Exchange Standards and Plans
State or regional exchanges; private and co-op plans offered; essential health
benefits 60%–90% actuarial value, four tiers plus young adults policy; insurers
must meet medical loss ratio of 80 percent for individual and small groups, 85
percent for large groups
Innovative Payment Pilots: Medical
Homes, Accountable Care Organizations,
Bundled Hospital and Post-Acute Care
Allow Medicaid beneficiaries to designate medical home; ACOs to share
savings in Medicare; CMS Innovation Center
Productivity Improvements
Modify market-basket updates to account for productivity improvements
Primary Care
10% bonus payments for 5 years; Federal funding for Medicaid payment rates
to primary care physicians no less than 100% of Medicare rates in 2013 and
2014.
Prevention and Wellness
Provide annual wellness visit and/or
health risk assessment for Medicare beneficiaries; strengthen state and
employer wellness programs; remove
cost-sharing for proven preventive services
Comparative Effectiveness
Create Patient-Centered Outcomes Research Institute
Quality Improvement
Direct HHS to develop national quality strategy, public reporting
Note: ACO = accountable care organization; PCP = primary care physician; AHRQ = Agency for
Healthcare Research and Quality. HHS = Department of Health and Human Services
Source: Commonwealth Fund analysis.
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FUND
Uninsured Nonelderly Under Baseline
and the Affordable Care Act in 2022, by State
Baseline
Affordable Care Act
VT
WA
MT
NH
ME
VT
WA
ND
MT
MN
OR
NY
WI
SD
ID
MI
WY
NE
NV
UT
CA
PA
IA
IL
CO
KS
MO
OH
IN
WV
OK
NM
ID
MS
AL
MI
WY
NV
PA
IA
NE
IL
UT
CO
CA
KS
WV
MO
VA
KY
DE
MD
DC
NC
OK
NM
SC
AR
MS
TX
OH
IN
MA
RI
NJ CT
TN
AZ
GA
NY
WI
SD
SC
AR
ME
ND
MN
OR
DE
MD
DC
NC
TN
AZ
VA
KY
MA
RI
NJ CT
NH
AL
GA
LA
TX
FL
LA
FL
AK
4%–<10%
20%–<25%
10%–<15%
25%–<30%
15%–<20%
30%–<35%
AK
HI
22% of nonelderly uninsured
HI
10% of nonelderly uninsured
Note: Baseline scenario is if the Affordable Care Act had not been enacted in 2010; Affordable Care Act is full
implementation of the law; Romney plan includes full repeal of the Affordable Care Act and replacement with
state block grants for the Medicaid program and equalization of the tax treatment of individually purchased
health plans and employer plans.
Source: S.R. Collins, S. Guterman, R. Nuzum, M.A. Zezza, T. Garber, and J. Smith. Health Care in the 2012
Presidential Election: How the Obama and Romney Plans Stack Up (New York: The Commonwealth Fund, October
2012) .
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COMMONWEALTH
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The Affordable Care Act and Vulnerable Populations
“How effective do you feel the Affordable Care Act will be in addressing the following issues for vulnerable populations?”
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COMMONWEALTH
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Source: Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, Aug. 2011.
Impact of Health Reform on National Health Expenditures
NHE in trillions
$5.0
Before Reform*
$4.5
6.3% annual
growth
$4.3
After Reform
$4.0
$4.6
5.7% annual
growth
$3.5
$3.0
$2.5
$2.5
$2.0
$1.5
Total savings = $1.0 Trillion
$1.0
$0.5
$0.0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Notes: * Estimate of pre-reform national health spending when corrected to reflect underutilization of services by
previously uninsured.
Source: D. M. Cutler, K. Davis, and K. Stremikis, The Impact of Health Reform on Health System Spending,
(Washington and New York: Center for American Progress and The Commonwealth Fund, May 2010).
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COMMONWEALTH
FUND
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Payment and Delivery System Reforms Can Help
Build a High Performance Health System
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COMMONWEALTH
FUND
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The Problem: Fragmented Health Care Delivery and
Financing, Inconsistent Incentives That Often
Punish Efforts to Provide Better Care
• The Diagnosis: The U.S. health system has multiple co-morbidities,
but one of the fundamental problems for patients is fragmentation
of providers and fragmentation of care delivery
– Poor care coordination and care transitions
– Sub-optimal quality and efficiency
• The Treatment: Policies that change the way health care is
organized, delivered, and paid for, to elicit and reward better
results
– Foundation of patient-centered primary care
– Coordination of care among multiple providers and care
settings
– Accountability for the total care of a patient
– Payment reform
– Optimal use of health information technology
– Continuous quality and efficiency improvement
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FUND
What Provider Delivery System and Payment
Reforms are Being Tested/Implemented?
•
•
•
•
•
•
Accountable Care Organizations
– Shared savings
– Shared savings and shared risk
– Global payment -- partial or full capitation
Patient-Centered Medical Homes
– Blended fee for service, care management fee, bonuses for quality
Bundled payment for acute hospital episodes
– Inpatient hospital care and inpatient physician services
– Inpatient hospital care, inpatient physician services, post-acute care
services
Value-Based Purchasing
Tools, infrastructure support
• Enhanced care coordination/chronic disease management
• Health information technology
• Beacon communities; health information exchanges
Combination strategy in innovator communities
33
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Accelerating system change
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COMMONWEALTH
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High Performance Health System Criteria for
Developing Options to Stabilize Spending Growth
• Set targets for total spending growth
• Pay for value to accelerate delivery system reform for
better outcomes, better care, at lower costs
• Address the systemwide causes of health spending
growth―not just federal health costs
• Align incentives for providers and consumers across
public and private payers
• Protect access and enhance equity, but also engage
and inform consumers
• Invest in information systems to guide action
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COMMONWEALTH
FUND
A Synergistic Strategy for Improving System Performance
Payment reforms to accelerate delivery system innovation ($1,333 billion)
• Pay for value: replace the SGR with provider payment incentives to improve care
• Strengthen patient-centered primary care and support care teams
• Bundle hospital payments to focus on total cost and outcomes
• Align payment incentives across public and private payers
Policies to expand and encourage high-value choices ($189 billion)
• Offer new Medicare Essential plan with integrated benefits through Medicare, offering
positive incentives for use of high-value care and care systems
• Provide positive incentives to seek care from patient-centered medical homes, care teams,
and accountable care networks (Medicare, Medicaid, private plans)
• Enhance clinical information to inform choice
Systemwide actions to improve how health care markets function ($481 billion)
• Simplify and unify administrative policies and procedures
• Reform malpractice policy and link to payment*
• Target total public and private payment (combined) to grow at rate no greater than GDP
per capita**
Notes: SGR = sustainable growth rate formula; GDP = gross domestic product.
* Malpractice policy savings included with provider payment policies.
** Target policy was not scored.
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COMMONWEALTH
FUND
Projected National Health Expenditures (NHE), 2013–2023:
Potential Impact of Synergistic Strategy
NHE in $ trillions
$6.0
Current baseline NHE projection
$5.5
Projected NHE net of policy impacts
$5.0
$5.1
$4.0
$2.9
$3.0
$2.0
$1.0
NHE as percentage of GDP—
Current projection: 18% in 2013→21% in 2023
Under proposed strategy: 18% in 2013→19% in 2023
Cumulative NHE savings under proposed strategy: $2.0 trillion
$0.0
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Note: GDP = gross domestic product.
Source: Estimates by Actuarial Research Corporation for The Commonwealth Fund. Current baseline projection
assumes that the cuts to Medicare physician fees under the sustainable growth rate (SGR) formula are repealed and
basic physician fees are instead increased by 1% in 2013 and held constant from 2014 through 2023.
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COMMONWEALTH
FUND
Impact of Synergistic Strategy on Projected Annual
Hospital and Physician Spending, 2013–2023
Spending in $ billions
$2,000
Hospital (baseline)
Hospital (net of policy impacts)
$1,750
$1,646
Physician (baseline)
$1,500
Physician (net of policy impacts)
$1,509
$1,250
$1,122
$1,000
$902
$750
$597
$1,055
Projected growth of hospital spending, 2013–2023:
• Baseline projection: 82% (6.2% annual)
• Net of policy impact: 67% (5.3% annual)
Projected growth of physician spending, 2013–2023:
• Baseline projection: 88% (6.5% annual)
• Net of policy impact: 77% (5.9% annual)
$500
$250
$0
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
THE
Source: Estimates by Actuarial Research Corporation for The Commonwealth Fund. Current baseline projection assumesCOMMONWEALTH
that
FUND
the cuts to Medicare physician fees under the sustainable growth rate (SGR) formula are repealed and basic physician fees are
instead increased by 1% in 2013 and held constant from 2014 through 2023.
There Are Hopeful Signs: The Health System Already is
Responding to the Challenge to Provide Better Care
•
39
Meaningful use of health IT –
•
physicians with Electronic Health Records doubled from 17 to 34 percent in last
there years
•
half of all hospitals have registered for a Medicare or Medicaid EHR Incentive
Payment; $2.5 billion in EHR incentive payments
•
50,000 health IT-related jobs created since the enactment of the HITECH Act
(BLS)
•
Hospitals/physicians are participating in care transformation collaboratives
•
32 Pioneer ACOs – committed to moving faster toward accountability
•
Primary care and Medical homes – Comprehensive Primary Care Initiative; 41 state
Medicaid programs supporting initiatives
•
Bundled payment – Acute Care Episode demonstration, CMS bundled payment
initiative
•
Community-based Transitions Program – 7 communities in Arizona; Atlanta; Akron;
Merrimack Valley (MA), Southern Maine, and Chicago selected as of January 2012;
aims to improve post-hospital discharge care transitions and reduce hospital
readmissions
•
Partnership for Patients -- 6,900 hospitals and organizations pledged their
THE
commitment to a national campaign to improve the safety and coordination of care
COMMONWEALTH
FUND
40
Thank You!
David Blumenthal, M.D.
President
Chair, Commission on a High
Performance Health System
[email protected]
Cathy Schoen
Senior Vice
President, Research
& Evaluation
[email protected]
Mark Zezza
Senior Program
Officer, Payment
& System Reform
[email protected]
The Commonwealth Fund Commission
on a High Performance Health System
Melinda Abrams
Vice President,
Patient-Centered
Coordinated Care
[email protected]
Sara Collins
Vice President,
Affordable Health
insurance
[email protected]
For more information, please visit: www.commonwealthfund.org
THE
COMMONWEALTH
FUND