The Obama administration, acting in concert with the health insurance trade group America's Health Insurance Plans (AHIP), announced today an agreement to develop a standardized set of healthcare quality measures for physicians. In particular, the new quality measurement system will track care given by accountable care organizations, patient-centered medical homes, primary care physicians, cardiologists, gastroenterologists, HIV and hepatitis C care providers, medical oncologists, orthopedists, obstetricians and gynecologists.
As physician's pay from insurance plans is more and more tied to quality outcomes - did the patient get well, or will there be additional claims down the road? - a system for measuring outcomes has become necessary. In recent years, government and private health plans have been working separately, and a confusing array of different measures for different companies has been growing. The CMS/AHIP agreement will seek to create a single standard system of measurement, relieving much of the burden caused by separate systems. In their news release, acting CMS administrator Andy Slavitt stated that "this agreement today will reduce unnecessary burdens for physicians and accelerate the country's movement to better quality." Representatives of the American Medical Association and the Americal Academy of Family Physicians praised the effort.
Showing posts with label affordable care act. Show all posts
Showing posts with label affordable care act. Show all posts
February 16, 2016
February 8, 2013
Exchange and Medicaid IT Contract Tracker
State Refor(u)m has created a chart that tracks states' choices of firms to build health insurance exchanges and Medicaid systems, with details on technical roles performed by vendors and on some of the software components vendors will use. The chart was produced by the Office of Health Policy and Technology at the University of Massachusetts Medical School. States can help State Refor(u)m keep the tool updated by using the page's comments section to post information about similar contracts awarded in their states.
Visit the Exchange and Medicaid Systems Contracts Chart to see who's doing what on whose project, and to add your own.
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CarePrecise is a sponsor of Big Data for Healthcare Forum, April 29 - May 1, 2013. Join us there!
CarePrecise provides healthcare provider information to state insurance exchanges, health information exchanges, Sunshine Act programs, healthcare fraud investigations and other state and federal healthcare projects.
Visit the Exchange and Medicaid Systems Contracts Chart to see who's doing what on whose project, and to add your own.
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CarePrecise is a sponsor of Big Data for Healthcare Forum, April 29 - May 1, 2013. Join us there!
June 30, 2012
Population Healthcare Is Health Reform
Michael Christopher
Chief Chigger, CarePrecise Technology
We have heard many people say that the Affordable Care Act is not health reform, but an attempt at health insurance reform. But a broad shift in the focus and delivery of healthcare has begun, shaped in part by the ACA, and poised to bring significant change to American healthcare. At the heart of that change is population-based healthcare.
"With the Supreme Court upholding the ACA, we all now understand that population healthcare is what we're all going to be doing going forward," says Dr. Steven Davidson, senior vice president and chief medical informatics officer for New York's Maimonides Medical Center in a June 28 Modern Healthcare article. What is "population healthcare," what does it have to do with the Affordable Care Act, and what does it mean to industry vendors?
The term refers to "the ability to assess the health needs of a specific population; implement and evaluate interventions to improve the health of that population; and provide care for individual patients in the context of the culture, health status, and health needs of the populations" according to the Association of American Medical Colleges. Population healthcare is a broadening of focus to see beyond the individual patient to the broad context of that patient's health issues, and to understand the issues of the patient's population to better serve both the individual patient and broader communities of patients.
This perspective becomes ever more critical when cost efficiencies are taken seriously into account, as they must be in an "affordable care" paradigm. In a Tufts Managed Care Institute's white paper on population health, we find
When viewed through the lens of health reform's quality focus, public health data collection and bringing the technologies that enable collection to every point of care, population healthcare is seen as a key - if not the key - strategy for both implementing the provider side of health reform, and rewiring its financial backbone of health insurance.
* Boland P., editor. Redesigning Heath Care
Delivery. Boland Health Care, Berkeley,
1996. pp. 159-163.
** Zeich R. Patient identification as a key to
population health management. New
Medicine. 1998;2:109-116.
Chief Chigger, CarePrecise Technology
We have heard many people say that the Affordable Care Act is not health reform, but an attempt at health insurance reform. But a broad shift in the focus and delivery of healthcare has begun, shaped in part by the ACA, and poised to bring significant change to American healthcare. At the heart of that change is population-based healthcare.
"With the Supreme Court upholding the ACA, we all now understand that population healthcare is what we're all going to be doing going forward," says Dr. Steven Davidson, senior vice president and chief medical informatics officer for New York's Maimonides Medical Center in a June 28 Modern Healthcare article. What is "population healthcare," what does it have to do with the Affordable Care Act, and what does it mean to industry vendors?
The term refers to "the ability to assess the health needs of a specific population; implement and evaluate interventions to improve the health of that population; and provide care for individual patients in the context of the culture, health status, and health needs of the populations" according to the Association of American Medical Colleges. Population healthcare is a broadening of focus to see beyond the individual patient to the broad context of that patient's health issues, and to understand the issues of the patient's population to better serve both the individual patient and broader communities of patients.
This perspective becomes ever more critical when cost efficiencies are taken seriously into account, as they must be in an "affordable care" paradigm. In a Tufts Managed Care Institute's white paper on population health, we find
"Population-based care involves a new way of seeing the masses of individuals seeking health care. It is a way of looking at patients not just as individuals but as members of groups with shared health care needs. This approach does not detract from individuality but rather adds another dimension, as individuals benefit from the guidelines developed for the populations to which they belong.* Members with a particular disease must be prioritized so that disease management interventions are targeted toward those members most likely to cost-effectively benefit.**"The Affordable Care Act package as it now stands places the emphasis on results, rather than on specific means to obtain results. Despite what has been said by opponents, providers are given wide freedom in achieving improved quality and reach of care, and are provided with new resources, such as advanced electronic health records, paid for in part by the taxpayer. Population healthcare is a strategy for deploying these resources and creative latitudes, in a package of practical tactics and achievable objectives, and at scale.
When viewed through the lens of health reform's quality focus, public health data collection and bringing the technologies that enable collection to every point of care, population healthcare is seen as a key - if not the key - strategy for both implementing the provider side of health reform, and rewiring its financial backbone of health insurance.
* Boland P., editor. Redesigning Heath Care
Delivery. Boland Health Care, Berkeley,
1996. pp. 159-163.
** Zeich R. Patient identification as a key to
population health management. New
Medicine. 1998;2:109-116.
June 29, 2012
Now We Know: Time to implement the Affordable Care Act
As the Tennessee Medical Association puts it, there is now a "certain finality" to the Affordable Care Act following the Supreme Court decision upholding the law. A huge win for the Obama administration, the decision yesterday was like kicking a hornet's nest among conservatives. The Christian Medical Association said the decision "sounds an alarm across the country to people with faith-based and pro-life convictions" and called on Congress to repeal the law.
An article in Modern Physician characterizes the response among physicians as "mixed," but the vast majority of our MD, DO, PA and RN contacts have come down strongly in favor of the law, in one case saying "The government did something right... 50 million healthier Americans is going to look pretty good here in a few years."
Whichever political side one is on, it is now clear that work can move forward on implementing the law. The Tennessee Medical Association's statement concluded "Today's decision allows us to make more definitive plans regarding reforms to our healthcare system in Tennessee." The sentiment seems to be fairly widespread through the provider side of the industry.
Some states - among them our own Oklahoma - elected to refuse federal funding ($54 million in Oklahoma's case) to establish health insurance exchanges. The decision, taken on the part of Governor Mary Fallin, appears to have been politically motivated, but Oklahoma is, in fact, developing an exchange, without the federal dollars. An agency head, speaking with an Oklahoma radio station, said "It would have been good to have the money, so we could have a more user friendly and effective system, but we'll have something, anyway."
The justices struck down provisions in the law that would empower the federal government to force states to comply with the planned Medicaid expansion or lose all of their Medicaid funding. Now states will be eligible for basic Medicare funding even if they choose not to accept the additional dollars to provide expanded care. Numerous states have sworn to refuse expanded Medicaid funding, but it remains to be seen whether any will ultimately deny this added coverage for hundreds of thousands of their citizens. The federal dollars are being offered with no required match for three years. Medicaid is often one of the biggest lines in states' budgets, and that share is growing as healthcare costs continue to rise.
An article in Modern Physician characterizes the response among physicians as "mixed," but the vast majority of our MD, DO, PA and RN contacts have come down strongly in favor of the law, in one case saying "The government did something right... 50 million healthier Americans is going to look pretty good here in a few years."
Whichever political side one is on, it is now clear that work can move forward on implementing the law. The Tennessee Medical Association's statement concluded "Today's decision allows us to make more definitive plans regarding reforms to our healthcare system in Tennessee." The sentiment seems to be fairly widespread through the provider side of the industry.
Some states - among them our own Oklahoma - elected to refuse federal funding ($54 million in Oklahoma's case) to establish health insurance exchanges. The decision, taken on the part of Governor Mary Fallin, appears to have been politically motivated, but Oklahoma is, in fact, developing an exchange, without the federal dollars. An agency head, speaking with an Oklahoma radio station, said "It would have been good to have the money, so we could have a more user friendly and effective system, but we'll have something, anyway."
The justices struck down provisions in the law that would empower the federal government to force states to comply with the planned Medicaid expansion or lose all of their Medicaid funding. Now states will be eligible for basic Medicare funding even if they choose not to accept the additional dollars to provide expanded care. Numerous states have sworn to refuse expanded Medicaid funding, but it remains to be seen whether any will ultimately deny this added coverage for hundreds of thousands of their citizens. The federal dollars are being offered with no required match for three years. Medicaid is often one of the biggest lines in states' budgets, and that share is growing as healthcare costs continue to rise.
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