Best Care at Lower Cost The Path to Continuously Learning Health Care in America (2013) / Chapter Skim
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Appendix C: ACA Provisions with Implications for a Learning Health Care System
Appendix C: ACA Provisions with Implications for a Learning Health Care System
Pages 389-400
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From page 389... ...
• Requires the HHS Secretary to develop a National Strategy to Improve Health Care Quality to improve health outcomes and effi ciency, identify areas for improvement, address gaps in comparative effectiveness information and data gathering, and improve research and dissemination of best practices. The national strategy must be updated annually, with the initial report submitted to Congress by January 1, 2011.
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From page 390... ...
The ACA appropriates $60 million per year for fiscal years 2010 through 2014 to the Medicaid Quality Measurement Program for a total appropriation of $300 million. • Creates a quality measures reporting system for long-term care hospitals, inpatient rehabilitation facilities, cancer hospitals, and hospice programs.
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From page 391... ...
Condition-Specific Care Improvement • Creates a National Congenital Heart Disease Surveillance System to track epidemiological data on heart disease and identify areas for prevention and outreach. • Establishes Centers of Excellence for Depression, a network of organizations that will develop and implement evidence-based treatment and prevention standards, foster communication with stakeholders, leverage community resources, and promote the use of electronic health records to coordinate and manage treatment of depressive disorders.
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From page 392... ...
• Establishes an Independent Payment Advisory Board, a Board of 15 members appointed by the President and confirmed by the Senate that will recommend to Congress ways to slow the rate of growth in national health expenditures while preserving quality of care. Beginning January 15, 2014, in years when the CMS Chief Actuary projects Medicare spending growth to exceed the target growth rate for the year, the Board must submit to Congress and the President a proposal to reduce Medicare spending.
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From page 393... ...
• Creates an Independence at Home demonstration program to pro vide home primary care services for high-need Medicare patients and allow providers to share in cost savings. State Initiatives • Requires health plans to report their medical loss ratios and pro vide rebates to consumers if less than 85 percent of their premium (for large group market plans)
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From page 394... ...
• Creates a Medicaid demonstration program requiring states to reimburse qualified mental health care institutions for services to stabilize Medicaid beneficiaries experiencing an emergency psychi atric condition. • Requires non-profit hospitals to conduct community needs assess ments, taking into account input from the community served by the hospital, and adopt implementation strategies to meet identified needs.
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From page 395... ...
In Phase I of CMMI's operation, CMMI will test payment and service delivery models for their effect on public expenditures and quality of care. Models to be evaluated include -- Promoting patient-centered medical homes in primary care -- Contracting directly with providers, services, and suppliers -- Utilizing geriatric assessments and comprehensive care plans to coordinate care for patients with multiple chronic conditions -- Promoting care coordination between providers and suppliers to transition away from fee-for-service reimbursement and toward salary-based payment -- Supporting care coordination for chronically ill patients through the use of health IT-enabled provider networks, including care coordinators, a chronic disease registry, and home tele-health technology -- Varying payment to physicians ordering advanced diagnostic imaging services according to the appropriateness of the service ordered -- Utilizing medication therapy management services -- Establishing community-based health teams by assisting primary care providers in chronic care management -- Assisting patients in making informed health care choices by paying providers for using patient decision-support tools -- Allowing states to test and evaluate integration of care for dual eligibles
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From page 396... ...
The law also appropriates funding for CMMI indefinitely, with a $10 billion appropriation for fiscal years 2011 through 2019, and $10 billion more for each subsequent 10 fiscal year period. • Provides an Encouraging Investment in New Therapies tax credit to encourage investments in new therapies to prevent and diagnose acute and chronic diseases.
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From page 397... ...
• Establishes a formal licensing process for approving biosimilar therapeutics, with data exclusivity periods established to encourage creation of new biologics. • Awards 5-year demonstration grants to states to develop, evaluate, and implement alternatives to current medical malpractice litiga tion, with preference given to states that consult relevant stake holders and propose alternatives likely to reduce medical errors and improve patient safety.
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From page 398... ...
• Provides financial incentives under Medicare and Medicaid to en courage hospitals, physicians, and health professionals to become meaningful users of health IT by using certified electronic health record technology in ways that allow the electronic exchange of information to improve health care quality. • Encourages state Medicaid agencies to adopt a meaningful use incentive program similar to the federal program.
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From page 399... ...
• Supports development of training programs focused on prevention, public health, primary care, medical homes, team management of disease, and integration of mental and physical health services.
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