Cost and Quality Relationship Memo Essay

Many of the reforms contained within the Patient Protection and inexpensive Care Act (PPACA) are aimed at cut back health do costs and improving quality without rationing mete out, cutting benefits or step-down eligibility. Starting with the populations that suffer from the more or less difficult health conditions and have the most medical expenses makes sense. If designed and implemented properly, these reforms hold the potential to transform not only their lives, but excessively to serve as models for other populations. However, this holler cannot be realized without the informed and meaningful participation of tolerants, families and their advocates.The problem our split systemThere is widespread acknowledgement that our current health finagle system is fragmented, failing to consistently deliver graduate(prenominal) quality care, oddly to certain vulnerable people, such as those with multiple chronic conditions, the imperfect elderly, people who are du solelyy eligi ble for Medicare and Medicaid, and members of a racial or social minority. These populations tend to see more physicians, have more office visits and oblige more medications. Too often, there is no one to coordinate this care. This ill to coordinate leads to poor care, such as Duplicative tests or procedures Medication errors evitable hospital admissions Preventable hospital readmissions Unnecessary nursing home placementsThis atomisation comes at a cost. Overall, health care costs represent 16 percent of our Gross Domestic Product. In 2009, we spent $2.9 trillion on health care. The cost of health care services provided to vulnerable populations is disproportional 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 a good deal for the nearly nine million dually eligible beneficiaries than for non-duals. This disproportionate spe nding is in part because these populations have more complex health care needs. tho preventable hospitalizations, complications and unnecessary nursing home admissions contribute significantly to these high costs. Improving the health delivery system for these vulnerable people leave behind improve the quality of their lives, while also saving money.Page 2 National health Reform and Delivery System Change, June 2010 Community gun is a national non-profit advocacy organization building consumer and community leadership to transform the American health care system. www.communitycatalyst.org2New opportunities rising from national health care reformNoted Harvard surgeon and write Atul Gawande said 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 explanations. Drawing from whats worked in agriculture, he said that to figure out ho w to transform medical communities, with all their diversity and complexity, is going to involve trial and error. And this allow for require pilot light 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 to a fault many reforms to cover, this brief aims to discuss some those that hold the most shiny for states to improve the health of vulnerable populations.In exchange, designated providers receiving payment for these services essential provide regular reports to the state on a set of pertinent quality measures. The New Jersey Legislature is currently considering a bill that would create a primary care medical home display discombobulate. Should that bill pass, New Jersey could explore taking this state option, and advocates could squeeze in on the development of quality measures that are most relevant to vulnerab le populations.Accountable care organizations (ACOs)The new fairness creates a universal ACO pilot program in Medicare4 and a pediatric ACO demonstration project in Medicaid,5 in which crowds of providers who work together to improve the quality of care they deliver to beneficiaries will be permitted to keep half the savings they light upon 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 demonstrate that they meet patient-centeredness criteria, such as the use of patient and phencyclidine judgements 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 Human 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 Jers ey in creating an ACO demonstration project to serve urban, underserved communities. Creating a state project may position New Jersey to coach 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 checkup Assistance Percentage (FMAP) payments to States that decrease the percentage of spending while increase spending on HCBS.