Thursday, January 29, 2015

The other health care revolution: accountability

Not since the advent of Medicare in the 1960s has our nation' health care undergone the kind of sweeping transformation we're seeing today.

The other health care revolution: accountability

Not since the advent of Medicare in the 1960s has our nation’s health care undergone the kind of sweeping transformation we’re seeing today.

While the Affordable Care Act and the millions of people who are newly insured are grabbing most of the headlines, there is another important story in health care that’s not to be missed. Physicians, hospitals, and health insurers are now joining forces collaboratively to create new ways to raise the quality of care, lower costs, and increase patient satisfaction. 

These new approaches to care are important because well-respected studies estimate that 30 percent of every health care dollar goes towards care that is ineffective or redundant. With national spending on health care topping $2.8 trillion each year, it’s imperative that we find ways to raise quality and rein in costs on behalf of consumers and employers.

That’s why health insurers are radically changing how they compensate physicians and hospitals, moving from an antiquated model which pays for the quantity of services provided – and does not consider quality or effectiveness – to a new model that rewards improving quality and lowering cost.

One such new model is Accountable Care Organizations (ACOs) – groups of doctors, hospitals, and other health care providers that come together to provide highly coordinated, high quality care to their patients.  The tremendous potential of ACOs is exciting for everyone in health care, and for consumers and employers. 

A survey of Blue Cross plans throughout the United States released last month highlights the size of the investment being made in these and similar initiatives.  Altogether, these plans are spending more than $65 billion a year—about one in five medical claim dollars—on value-based programs like ACOs.

Here in our region, more than 90 percent of the health care systems are participating in an ACO payment model initiated by Independence Blue Cross. The initial results are extremely encouraging:

  • Nearly 90 percent of the hospitals participating lowered readmission rates, with an average reduction of 16 percent.
  • 100 percent of the participating health systems improved on at least one hospital-acquired infection measure or received a top distinction from the Pennsylvania Department of Health for infection control.
  • Nearly all participants scored better in measures that assess patients’ experience during their hospital stay, such as how well patients understand the information they receive about recovery before they are sent home.
  • Half of the hospitals participating successfully reduced their medical costs, based on total medical costs for the defined group of members. The customized targets are set based on historical utilization and costs.  

When doctors, hospitals, and other health care professionals, and health insurers work together to boost the quality of care, lower costs, and raise patient and physician satisfaction, everyone wins. 

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Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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