Cost and Quality Relationship Memo Essay

Many of the reforms contained within the Patient Protection and Affordable thrill Act (PPACA) are aimed at reducing wellness care cost and improving spirit without rationing care, cutting benefits or reducing eligibility. starting line with the populations that suffer from the most difficult health conditions and have the most medical expenses makes sense. If designed and implemented properly, these reforms hold the potential to substitute not wholly their lives, but also to serve as models for other populations. However, this promise cannot be realized without the informed and meaningful fictitious charactericipation of patients, families and their advocates.The problem our fragmented administrationThere is widespread acknowledgement that our current health care system of rules is fragmented, failing to consistently slant high fiber care, particularly to received undefendable battalion, such as those with nine-fold chronic conditions, the frail elderly, people who are dually eligible for Medicare and Medicaid, and members of a racial or ethnic minority. These populations run away to see more(prenominal) physicians, have more office visits and take more medications. Too often, on that point is no one to consecrate this care. This failure to coordinate leads to poor care, such as Duplicative tests or procedures Medication errors Avoidable infirmary admissions Preventable hospital readmissions Unnecessary nursing home placementsThis fragmentation comes at a cost. Overall, health care cost represent 16 percentage of our Gross Domestic Product. In 2009, we spent $2.9 trillion on health care. The cost of health care services reard to vulnerable populations is disproportionate to their numbers. For instance, 96 percent of Medicare dollars and 80 percent of Medicaid dollars are spent on patients with multiple chronic conditions. And, Medicaid and Medicare spend four times as much for the virtually nine million dually eligible beneficiaries than fo r non-duals. This disproportionate disbursal is in part because these populations have more complex health care needs. But preventable hospitalizations, complications and unnecessary nursing home admissions contribute significantly to these high costs. upward(a) the health deli real system for these vulnerable people bequeath make better the quality of their lives, while also saving money.Page 2 field of study Health Reform and Delivery System Change, June 2010 Community Catalyst is a topic non-profit advocacy organization building consumer and community leadership to transform the American health care system. www.communitycatalyst.org2 immature opportunities emerging from national health care reformNoted Harvard surgeon and author Atul Gawande express it best in his December 2009 New Yorker article Testing, Testing, where he responded to claims that there was no master plan for improving quality and reducing costs in the then-pending national reform snouts. Drawing from wha ts worked in agriculture, he said that to figure out how to transform medical communities, with all their alteration and complexity, is going to involve trial and error. And this will require pilot lamp programs a lot of them. Indeed, the PPACA is filled with just these types of reforms aimed at testing what works. By its very nature, it acknowledges the differences among health delivery systems. While there are too numerous reforms to c everywhere, this brief aims to discuss some those that hold the most promising for severalizes to better the health of vulnerable populations.In exchange, designated leadrs receiving payment for these services must provide regular tells to the state on a set of applicable quality measures. The New Jersey Legislature is currently considering a bill that would puddle a primary care medical home demonstration project. Should that bill pass, New Jersey could explore taking this state option, and advocates could weigh in on the development of qua lity measures that are most relevant to vulnerable populations.Accountable care organizations (ACOs)The new law creates a general ACO pilot program in Medicare4 and a pediatric ACO demonstration project in Medicaid,5 in which groups of providers who work together to improve the quality of care they deliver to beneficiaries will be permitted to keep half the savings they achieve over a three-year period. Participating ACOs must promote evidence-based medicine and patient engagement, report on quality and cost measures and coordinate care. They must also salute that they meet patient-centeredness criteria, such as the use of patient and caregiver assessments or the use of individualized health plans.The criteria by which a group of providers will be judged in order to qualify as an ACO will be determined by regulation issued by the Department of Health and serviceman Services, which will also determine the measures to be used to assess the quality of care provided by the ACO. There is already interest in New Jersey in creating an ACO demonstration project to serve urban, underserved communities. Creating a state project may position New Jersey to take advantage of the federal pilot funding. Home and community-based services (HCBS)The new law offers incentives to states that provide HCBS to individuals instead of placing them in nursing homes.6 Specifically, the law increases Federal Medical aid Percentage (FMAP) payments to States that decrease the percentage of spending while increasing spending on HCBS.