Z S's List: Journal Article - Israel US Healthcare

• In January 2013, if Democrats hold the White House and Senate and regain control of the House, the ACA will be implemented mostly as constructed.
• If Republicans capture the White House and Senate and retain House control, the ACA will face major deconstruction early in 2013.
• reforms such as the elimination of coverage exclusions for preexisting conditions
• state health insurance exchanges
• provision of private health insurance subsidies
• Those benefiting include more than 6 million young adults enrolled in their parents' insurance plans
• 5.2 million Medicare enrollees who have saved on prescription-drug costs because of the shrinking Part D “doughnut hole
• 600,000 new adult Medicaid enrollees in seven states that have already expanded Medicaid eligibility
• 12.8 million consumers who will receive more than $1 billion in insurance-premium rebates
• accountable care organizations, patient-centered medical homes, the Prevention and Public Health Fund, and the Patient-Centered Outcomes Research Institute
• numerous system reforms, such as
• Medicaid serve nearly all legal residents with incomes below 138% of the federal poverty level
• biggest change involves Medicaid
• states won't risk losing federal funding if they choose not to expand their Medicaid programs
• federal government will pay 100% of expansion costs between 2014 and 2016
• The law addresses far more than coverage, including health system quality and efficiency, prevention and wellness, the health care workforce, fraud and abuse, long-term care, biopharmaceuticals, elder abuse and neglect, the Indian Health Service, and other matters

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• efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment.
• Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers.
• Studies evaluated in this systematic review do not support the claim
• that the private sector is usually more efficient, accountable, or medically effective than the public sector
• public sector appears frequently to lack timeliness and hospitality towards patients.

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• (ACO) programs offer health care provider organizations contracts with Medicare
• organizations assume financial risk and are rewarded for providing high-quality care at lower cost
• spending targets will be determined on the basis of baseline Medicare spending for assigned populations,
• Medicare's use of national growth factors to set targets could cause ACOs in any HRR to gain or lose financially without altering their delivery of care.
• Using national growth rates to set ACO spending targets could also discourage participation by organizations in high-spending regions with tra
• ditionally high spending growth
• Pioneer payment contract, baseline ACO spending levels are determined by averaging fee-for-service Medicare spending for assigned beneficiaries over the 3 years preceding
• spending target is then calculated by adding to baseline spending 50% of the contemporaneous absolute (dollar) increase in national Medicare spending plus 50% of the relative (percentage) increase in national Medicare spending multiplied by the baseline spending
• If actual spending differs from the target by at least 1%, a Pioneer ACO shares 60 to 70% of the resulting savings or losses
• favored Pioneer participation most in low-spending, low-growth areas and put ACOs in high-spending, high-growth areas at a disadvantage
• range of favorability indicated that ACOs in many HRRs could have gained or lost substantially, as much as 14%
• Pioneer ACOs will probably face more variable favorability than our results suggest, because they will be subject to greater random changes in population health care needs.
• variation in local spending growth could cause many ACOs to achieve substantial savings or experience substantial losses that are unrelated to their efforts to improve efficiency in response to ACO contracts
• using national growth factors to set spending targets presents prospective ACOs with a sizable gamble
• discourage participation and limit expansion of ACO programs.
• local growth factors to set spending targets may better align savings for ACOs
• reduce the financial uncertainty involved in participation.
• might also diminish the incentives provided by the opportunity for savings
• ACOs would be rewarded only if they outperformed competitors in slowing spending growth
• some blend of local and national growth rates as ACO programs expand

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• health care providers, who come together voluntarily to give coordinated high quality care to their
• Medicare patients
• especially the chronically ill
• avoiding unnecessary duplication of services
• preventing medical errors
• helps a Medicare fee-for-service program providers become an ACO.
• Medicare Shared Savings Program
• Advance Payment Initiative
• supplementary incentive program for selected participants
• Pioneer ACO Model
• program designed for early adopters
• Participating in an ACO is purely voluntary

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• Promoting accountability
• coordinated care for all services provided under Medicare
• Encouraging investment in infrastructure
• redesigned care processes
• while meeting performance standards on quality of care and putting patients first
• reward ACOs that lower their growth in health care costs

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• already experienced in coordinating care
• move more rapidly from a shared savings payment model to a population-based payment model