America’s Agenda Recommendations in the Patient Protection and Affordable Care Act

Building Blocks for a Cost-Effective, High Quality Health System

 

DISEASE PREVENTION

  • Establishment of a National Prevention, Wellness, and Public Health Council charged with developing a national strategy to improve the nation’s health.
  • Establishment of a Prevention and Public Health Fund Funding for a grant program to support the delivery of evidence-based and community-based prevention and wellness services aimed at strengthening prevention activities, reducing chronic disease rates and addressing health disparities, especially in rural and frontier areas.
  • Medicare coverage for personalized prevention plan services
  • Financial incentives for state Medicaid provision of preventive services
 

CHRONIC DISEASE MANAGEMENT

  • Defines Community-based Health Teams and a grant program to establish them in the states - Needs Congressional appropriation
  • Independence at Home Demonstration Project to test home-based team care for high-risk patients New Medicaid plan option for multiple condition chronically ill patients based on care coordination and assignment of health homes
  • Medicaid Community Collaborative Network Program to coordinate care
 

INCENT PROVIDERS TO FORM AND JOIN HIGH-PERFORMANCE CARE DELIVERY ORGANIZATIONS

Accountable Care Organizations - permitted to share in cost savings they generate through participation of primary care docs, care coordination, promotion of evidence-based medicine, and reporting on care quality and costs
 

INCENT PROVIDER PROVISION OF BEST PRACTICE, HIGH-VALUE CARE, RATHER THAN HIGH-VOLUME OF CARE

  • Medicare Advantage Payments - adjusted to disincent fee-for-service provision of care Medicaid bundled payment demonstration projects National Pilot Program on Bundled Payments
  • Reduction of Medicare payments to some hospitals with high rates of hospital-acquired conditions
  • Creation of an Innovation Center to test innovations in payment structures and reduction of expenditures, while maintaining care quality
 

INCENT PATIENT COMPLIANCE WITH BEST PRACTICE CARE PLANS

Elimination of cost sharing for Medicare-covered preventive services No cost sharing for recommended preventative services in qualified health plans Removes patient cost-sharing for preventive services in state Medicaid programs
 

STRENGTHEN THE PRIMARY CARE WORKFORCE

  • Provide a 10% bonus payment to primary care physicians and to general surgeons practicing in health professional shortage areas, from 2011 through 2015
  • Funding to Increase workforce supply and support training of health professionals through scholarships and loans Funding to support primary care training and capacity building Funding to support the development of training programs that focus on primary care models such as medical homes, team management of chronic disease
 

STRENGTHENING THE EVIDENCE BASIS FOR BEST PRACTICE GUIDELINES AND QUALITY STANDARDS

  • Comparative Effectiveness Research supported by a establishing a Patient-Centered Outcomes Research institute
  • Requires development of a national quality improvement strategy (includes priorities for improving the delivery of health care services, patient health outcomes, and population health).
  • Creates process for the developing quality measures
 

ACCELERATED IMPLEMENTATION OF HEALTH INFORMATION TECHNOLOGY

  • Adoption of a single set of operating rules for administrative simplification by 2013
  • Implementation of electronic payments and remittances by 2014)
  • Implementation of electronic health claims, premium payments, referral authorizations by 2016
 

ACCESS BY ALL

  • Creates state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and cost- sharing credits available to individuals/families with income between 133-400% of the federal poverty level (the poverty level is $18,310 for a family of three in 2009)
  • Creates separate Exchanges through which small businesses can purchase coverage Imposes new regulations on health plans in the Exchanges and in the individual and small group markets. These include prohibition of coverage exclusions for pre-existing conditions and coverage recisions. Expands Medicaid to 133% of the federal poverty level.

Building Blocks for a Cost-Effective, High Quality Health System

 

DISEASE PREVENTION

  • Establishment of a National Prevention, Wellness, and Public Health Council charged with developing a national strategy to improve the nation’s health.
  • Establishment of a Prevention and Public Health Fund Funding for a grant program to support the delivery of evidence-based and community-based prevention and wellness services aimed at strengthening prevention activities, reducing chronic disease rates and addressing health disparities, especially in rural and frontier areas.
  • Medicare coverage for personalized prevention plan services
  • Financial incentives for state Medicaid provision of preventive services
 

CHRONIC DISEASE MANAGEMENT

  • Defines Community-based Health Teams and a grant program to establish them in the states - Needs Congressional appropriation
  • Independence at Home Demonstration Project to test home-based team care for high-risk patients New Medicaid plan option for multiple condition chronically ill patients based on care coordination and assignment of health homes
  • Medicaid Community Collaborative Network Program to coordinate care
 

INCENT PROVIDERS TO FORM AND JOIN HIGH-PERFORMANCE CARE DELIVERY ORGANIZATIONS

Accountable Care Organizations - permitted to share in cost savings they generate through participation of primary care docs, care coordination, promotion of evidence-based medicine, and reporting on care quality and costs
 

INCENT PROVIDER PROVISION OF BEST PRACTICE, HIGH-VALUE CARE, RATHER THAN HIGH-VOLUME OF CARE

  • Medicare Advantage Payments - adjusted to disincent fee-for-service provision of care Medicaid bundled payment demonstration projects National Pilot Program on Bundled Payments
  • Reduction of Medicare payments to some hospitals with high rates of hospital-acquired conditions
  • Creation of an Innovation Center to test innovations in payment structures and reduction of expenditures, while maintaining care quality
 

INCENT PATIENT COMPLIANCE WITH BEST PRACTICE CARE PLANS

Elimination of cost sharing for Medicare-covered preventive services No cost sharing for recommended preventative services in qualified health plans Removes patient cost-sharing for preventive services in state Medicaid programs
 

STRENGTHEN THE PRIMARY CARE WORKFORCE

  • Provide a 10% bonus payment to primary care physicians and to general surgeons practicing in health professional shortage areas, from 2011 through 2015
  • Funding to Increase workforce supply and support training of health professionals through scholarships and loans Funding to support primary care training and capacity building Funding to support the development of training programs that focus on primary care models such as medical homes, team management of chronic disease
 

STRENGTHENING THE EVIDENCE BASIS FOR BEST PRACTICE GUIDELINES AND QUALITY STANDARDS

  • Comparative Effectiveness Research supported by a establishing a Patient-Centered Outcomes Research institute
  • Requires development of a national quality improvement strategy (includes priorities for improving the delivery of health care services, patient health outcomes, and population health).
  • Creates process for the developing quality measures
 

ACCELERATED IMPLEMENTATION OF HEALTH INFORMATION TECHNOLOGY

  • Adoption of a single set of operating rules for administrative simplification by 2013
  • Implementation of electronic payments and remittances by 2014)
  • Implementation of electronic health claims, premium payments, referral authorizations by 2016
 

ACCESS BY ALL

  • Creates state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and cost- sharing credits available to individuals/families with income between 133-400% of the federal poverty level (the poverty level is $18,310 for a family of three in 2009)
  • Creates separate Exchanges through which small businesses can purchase coverage Imposes new regulations on health plans in the Exchanges and in the individual and small group markets. These include prohibition of coverage exclusions for pre-existing conditions and coverage recisions. Expands Medicaid to 133% of the federal poverty level.
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