Reform of responsible care organizations | Regulatory review

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.

• CMS should build on the empirical results of the performance of ACOs from the past decade to expand access to high-quality, low-cost healthcare, Todd Zegrang And the Jessica Bailey Whiton From Health Capital Consulting in Article – Commodity Posted in health lawyer. The U.S. Department of Health and Human Services’ Office of Inspector General conducted a study in 2019 of 20 high-performing executives, Zigrange and Bailey-Wheaton Discusses theCMS may be used to guide future regulatory reforms. Drawing on the report’s findings, Zigrange and Bailey-Wheaton deduce CMS should issue new regulations that require ACOs to develop robust primary care programs, which provide comprehensive patient-centered care, scale down costs and improve the quality of care.
• in study Posted in American Journal of Managed CareAnd the Nate C. carelessness subordinate University of Pennsylvania Perelman School of Medicine, Jay Holmgren From University of California, San FranciscoAnd the Rachel M subordinate University of Pennsylvania The Leonard Davis Institute for Health Economics explains that ACOs aim to improve coordination across individual health care programs, but they often fall short of this goal. Indifference, Holmgren and Werner have found ACO participation increases health information exchange between providers but this effect depends on the intensity of ACO in a particular market. Indifference, Holmgren and Werner deduce Policy makers should regulate data sharing more directly to facilitate ACO coordination, as the US Department of Health and Human Services previously did under 21^Street century cure law By establishing new centers to coordinate and accelerate the development of medical products.
• in study Posted in Population Health DepartmentAnd the Brandon W. Yang subordinate University of California, San Francisco School of Medicine Several co-authors distinguish between urban and rural ACO adoption rates. that they Discusses the That despite the steady growth of ACOs across the country, organizations in rural areas face unique challenges for formation and engagement. Analysis of relevant market factors – including physician focus, Medicare Advantage Commercial insurance coverage and registration—reveal ACO is more likely to be present in urban areas with lower concentrations of physicians and moderate Medicare Advantage participation. team yan explain That national regulations should promote ACO models that reduce barriers to participation of rural service providers.
• Despite constant efforts to integrate into their various programmes Social determinants of healthLike education and economic status, Medicaid ACOs currently have limited means to achieve these goals, to me Jennifera F. Murray From Boston University School of MedicineAnd the Hector B Rodriguez subordinate University of California, BerkeleyAnd the Valerie Lewis subordinate Gillings School of Public Health, University of North Carolina. in study Posted in Health Affairs, they sampled 22 ACOs to assess the state of social service integration. Murray, Rodriguez and Lewis deduce Barriers to integration will persist unless CMS issues guidance on how Medicaid dollars can be used for nonmedical programs and adds spending requirements for social needs.
• in Article – Commodity in Milbank QuarterlyAnd the Stephanie M Kisam From RTI International Several co-authors are evaluating CMSs state innovation model, which gave six states $250 million in total to test regulatory innovations aimed at transitioning to value-based models of care, such as ACOs. States to organize their healthcare systems by providing oversight for health insurers, healthcare professionals, and health insurance products, according to the Kisam team. that they have found Some policy tools have proven to be a consequence of state performance: compelling state law, regulations for insurers to require primary care investments, and required minimum spending on health information exchange systems. Kisame team Concludes State regulatory action that forces healthcare stakeholders to reform existing practices promotes health system change more effectively than financial investments.
• according to Marilyn Ozdavines From Nova Southeastern University in Article – Commodity Posted in Texas A&M Law Review. Ozdavines and suggest changes to Stark’s Law, a federal law prohibiting physician referrals to healthcare entities when there is a financial relationship between the referring physician and the entity, can improve the cost and quality of care. By clarifying key terms, modifying technical requirements that lead to unintended non-compliance, and creating a new value-based exception for CSOs, the revised Stark Act may help address legal barriers to providing improved health care, Argues Ozdavines.