Reform of responsible care organizations | Regulatory review

Experts explore opportunities to reduce costs and promote health equity.

According to some experts, the traditional fee-for-service structure used by these programs, in which the government Pay service providers separately for each particular service provided, to fail To provide adequate care to the participants. As health insurance is increasingly Become Can not be tolerated by taxpayers, the Biden administration has shown It will seek regulations aimed at reducing health care costs and expanding access to it. Management hopes to carrying out This is in part by encouraging access to Accountable Care Organizations (ACOs).

ACOs are a prime example of what is known as a value-based care structure, under which providers are paid based on patients’ health outcomes for services provided. ACOs are groups of healthcare providers who voluntarily agree to Coordination Providing high-quality care to Medicare and Medicaid recipients. ACOs minimum Health care costs by holding service providers collectively responsible for the quality and costs of care for their patients.

By replacing traditional fee-for-service payment systems, ACO . models are thought to be to improve Efficiency and equity by reducing wasteful spending and setting payments according to the needs of the population. In 2018, the Centers for Medicare and Medicaid Services (CMS) released a file Final rule That encouraged ACOs to increase savings and accelerate the transition to value-based models of care. These models, however, too Requires Technical support offices compensate the government if spending exceeds its target. As a result, many ACOs drop out of CMS software when their costs increased.

In response, CMS recently announce It plans to adjust Medicare-sponsored ACO programs in an effort to improve system efficiency and promote health equity. Suggested changes aim, shoot To broaden participation, reduce the accumulation of financial risk in technical support organizations, and achieve equal access to health care services. The ACO REACH . modelwhich is a beta program starting January 1, 2023 a test Shareholder enhancement features to improve delivery performance of ACOs.

Despite the ability of ACOs to bridge the gap between CMS aspirations and reality, Healthcare Providers Report Confrontation Difficulties in implementing ACOs. Critics assert that ACOs obstruct quality of care and fail To cut costs appropriately. but others Bearing I hope that, with some tweaking, tech support officials may continue to deliver on their promise to improve value-based care. While the ACO controversy continues, CMS attempt To find ways to salvage his ideal accountable care to lower healthcare costs and improve quality of care.

At a symposium on Saturday this week, scholars discuss whether technical support offices have failed to meet their goals and how regulatory reforms can improve their performance.

The Saturday Seminar is a weekly feature that aims to write the type of content that will be conveyed in a live seminar involving regulatory experts. every week, Regulatory review It publishes a brief overview of a specific regulatory topic and then summarizes recent research and scholarly writing on that topic.