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>>  2.1 Medical Homes and Team-Based Care
  • Promote quality and value through an improved, enrollment-based version of accountable care organizations (ACOs) called "Medicare Networks," formed and governed by providers. Read More >>
  • Eliminate SGR and transition from FFS-based system to Medicare Comprehensive Care (MCC). Read More >>
  • Improve the Federal Employees Health Benefits (FEHB) Program and use it to reform health care delivery. Read More >>
  • Repeal and replace the SGR with a Medicare physician payment policy that provides incentives to improve health outcomes and participate in care system innovation. Read More >>
  • Expand participation in CMS demonstrations and pilots by allowing rolling applications from providers. Read More >>
  • Expand Medicare, Medicaid, and private patient-centered medical home pilots to include more patients and providers. [page 7] [Medicare, Medicaid, Private Payers] Read More >>
  • Direct CMS to develop an improved physician-payment formula for the Medicare program that promotes participation in new models (such as ACOs and patient-centered medical homes), encourages care coordination across multiple providers, prioritizes primary care, and reduces Medicare costs. This would be enforced by the potential to reinstate a rebased SGR if a new formula is not implemented. [page 19] [Medicare]
>>  2.2 Accountable Care Organizations
  • Promote quality and value through an improved, enrollment-based version of accountable care organizations (ACOs) called "Medicare Networks," formed and governed by providers. Read More >>
  • Eliminate SGR and transition from FFS-based system to Medicare Comprehensive Care (MCC). Read More >>
  • Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  • Repeal and replace the SGR with a Medicare physician payment policy that provides incentives to improve health outcomes and participate in care system innovation. Read More >>
  • Expand participation in CMS demonstrations and pilots by allowing rolling applications from providers. Read More >>
  • Expand the use of ACOs under Medicare and within the private sector. [page 10] [Medicare, Medicaid, Private Payers] Read More >>
  • Direct the Centers for Medicare & Medicaid Services (CMS) to develop an improved physician-payment formula for the Medicare program that promotes participation in new models (such as ACOs and patient-centered medical homes), encourages care coordination across multiple providers, prioritizes primary care, and reduces Medicare costs. This would be enforced by the potential to reinstate a rebased SGR if a new formula is not implemented. [page 19] [Medicare]
>>  2.3 Medicare Private Plans
  • Establish a standardized minimum benefit for Medicare Advantage (MA) plans—including all services covered by traditional Medicare, a cost-sharing limit to protect against catastrophic expenses, and slightly lower cost-sharing—and pay plans using a competitive pricing system. Read More >>
  • Allow MA plans to return 100 percent of the difference between their bids and the benchmark to beneficiaries in the form of lower premiums (vs. 50% in the form of additional benefits) to encourage greater competition on price. [pages 20-21) [Medicare]
  • Implement the Medicare Payment Advisory Committee's (MedPAC) recommendation to empower the U.S. Secretary of Health and Human Services to vary cost-sharing based on evidence of a particular treatment's effectiveness. Read More >>
  • Allow MA plans to use tools that promote equality and value, such as using value-based insurance design (VBID) incentives (insurance design that relies on clinical research and data on provider performance as the basis for offering incentives to consumers to use evidence-based treatments and services and to obtain care from providers with a demonstrated ability to deliver quality, efficient health care) to induce beneficiaries to choose high-performing networks, or varying their cost-sharing based on the clinical effectiveness and value of services. [page 17] [Medicare] Read More >>
>>  2.4 State Innovation to Improve Quality and Reduce Costs
  • Provide continued opportunities for states to test alternative models designed to reduce insurance and utilization costs associated with medical liability litigation by appropriating the $50 million in state demonstration grants authorized in the Affordable Care Act (ACA) for the development, implementation, and evaluation of promising alternatives to current tort litigation. [page 107] Read More >>
  • Implement a standard program for person-focused Medicaid that includes support for capitated Medicaid managed care organizations, as well as state-directed reforms that focus on particular components of care. Read More >>
  • Require health insurance exchanges and state employee plans to offer tiered insurance plans that designate providers with high quality and low costs for patients (at least one tiered product at the bronze and silver levels by 2016). Read More >>
  • Accelerate payment policy innovations across federal and state public programs to stimulate change across the country and support local care system innovation. [page 25] [Medicare, Medicaid]
  • Expand participation in CMS demonstrations and pilots by allowing rolling applications from providers. Read More >>
  • States should take advantage of the "qualified entities" under the Availability of Medicare Data for Performance Measurement program to link Medicare, Medicaid, and commercial claims data to assist in making provider performance information available. [page 27] Read More >>
  • Implement a new waiver program to increase flexibility for states that are serious about controlling health care cost growth; establish presumptive eligibility criteria for up to 10 states over the next decade (eligible states are required to meet certain quality, efficiency, and cost of care objectives, and cannot increase the uninsured population). [page 24] [Medicaid] Read More >>
>>  2.5 Other Delivery System Reform Proposals
  • States and the Centers for Medicare & Medicaid Services (CMS) should facilitate the participation of Medicaid managed care plans in state insurance marketplaces to help mitigate shifts in and out of Medicaid eligibility; establish preferences for Medicaid plans for "optional" populations that align benefits with similar non-Medicaid plans in the marketplace. [page 24] [Medicaid] Read More >>
  • Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  • Encourage payers (both public and private) to develop more value-based insurance benefit designs using all-payer information on prices, quality, patient experiences, and outcomes of care. [page 28] [Medicare, Medicaid, Private Payers]
  • Expand participation in CMS demonstrations and pilots by allowing rolling applications from providers. Read More >>
  • Modify traditional Medicare benefits to allow tiered cost-sharing for providers, drugs, and services, provided that the modifications do not alter the overall actuarial value of Medicare for beneficiaries. [page 17] [Medicare] Read More >>
  • Give the Independent Payment Advisory Board (IPAB) expanded authority to change benefit design and reform cost-sharing rules and prevent IPAB from being restricted through special interest carve-outs. [page 21] [Medicare] Read More >>
Source: Katie Horton, J.D., M.P.H., R.N., Mary-Beth Malcarney, J.D., M.P.H., and Naomi Seiler J.D., George Washington University Department of Health Policy.