The Affordable Care Act encourages the formation of accountable care organizations (ACOs), with the hope that they will help providers work together more effectively to improve health care quality and slow spending growth. In a new Commonwealth Fund-supported commentary published in the Journal of the American Medical Association, two leading proponents of ACOs contend that rigorous performance measurement and evaluation will be critical to the success of these organizations.
In the commentary, Elliot S. Fisher, M.D., and Stephen M. Shortell, Ph.D., argue that performance measures in health care are too narrowly focused on individual clinicians, rather than the systems of care in which they operate. An integral part of implementing ACOs, they say, will be measuring processes and outcomes across the care continuum to support improvement and accountability and reduce the administrative burden associated with performance measurement.
The authors propose different measurement approaches, as well as a common framework for evaluating the range of delivery and payment reform initiatives in the Affordable Care Act to help determine which ACO characteristics are critical to their success.
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A new case study focuses on Montefiore Medical Center, an academic medical center in New York City that has created an integrated system of care for its primarily low-income patients. It uses innovative practices for managing chronic disease, provides access to high-quality specialty hospital care, and employs targeted care management and robust health information technology in support of integrated care. Although close to 80 percent of its revenues come from Medicaid and Medicare, Montefiore has been able to achieve financial sustainability. Read more »
The latest issue of States in Action describes provisions in the Affordable Care Act that assist states in expanding home- and community-based long-term care services and highlights innovative programs in Colorado, Michigan, and Rhode Island that seek to provide consumer-directed long-term care. Read more »
From 2007 to 2009, the four largest insurers in the individual market denied coverage to about one of every seven applicants on the basis of a preexisting medical condition, according to Jean P. Hall, Ph.D., associate research professor at the University of Kansas, in a new blog post. Hall outlines the provisions of the Affordable Care Act that will bridge the coverage gap for those denied coverage because of a preexisting condition—until a ban on this practice goes into effect in 2014. Read more »
Join a webinar on the state health insurance exchanges created by the Affordable Care Act. The webinar, to take place Nov. 4 at 2 p.m. ET, is the second in a series held by The Commonwealth Fund on realizing health reform's potential. Speakers will address the major challenges to successful implementation of the exchanges and present policy options and recommendations for federal and state officials, as well as provide an update on the status of the regulatory process and state implementation. Read more »
In the latest episode of New Directions in Health Care: The Commonwealth Fund Podcast, Sandy Hausman reports on the Safety-Net Medical Home Initiative, a Commonwealth Fund-supported demonstration project designed to help clinics that serve low-income patients become medical homes. Read more »
Commonwealth Fund President Karen Davis served as a panelist in a recent discussion on "The Long-Term Challenge: Next Steps in Health Care Reform," as part of an October 5 conference in Washington, D.C., on "America's Fiscal Future: Strengthening the Economy and Building the Future." A video of the event, organized by The Century Foundation, Center of Budget and Policy Priorities, Economic Policy Institute, and Demos, is now available. Other panelists were William Hoagland, vice president of public policy at Cigna, and Maggie Mahar, a fellow of The Century Foundation. Read more »
Comparative, comprehensive all-payer data on patient safety and hospital quality are available for the first time through WhyNotTheBest.org, The Commonwealth Fund's resource for reporting and comparing health care quality. The new data, derived from measures developed by the Agency for Healthcare Research and Quality (AHRQ), was submitted by hospitals in nine states—Arizona, Florida, New York, Illinois, New Jersey, Rhode Island, Texas, Vermont, and Washington. Patient safety indicators reflect quality of care for hospital patients and focus on potentially avoidable complications and medical mistakes. Hospital quality indicators include inpatient mortality for pneumonia, heart attack, stroke, and other medical conditions and procedures. Visitors to WhyNotTheBest.org can compare hospitals within and among states and can also make use of the case studies and improvement resources available on the Web site. Read more »
Have you had a chance to explore the Health Reform Resource Center, the most comprehensive tool for exploring and understanding the provisions of the Affordable Care Act? Visitors to the Center can view a timeline of the law's major provisions and use the "Find Health Reform Provisions" tool to search for clear, detailed summaries of specific provisions by year, category, and/or stakeholder group. Read more »