California 's Implementation Of Children 's Health Insurance Program Essay

Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.

The Arkansas Health Care Payment Improvement Initiative (“AHCPII”) is one part of the health care innovations the state has implemented with the aim of “increas[ing] health care quality and reducing the costs of care.” The AHCPII’s intent is to shift Arkansas’s payment system from “one that primarily rewards service volume to one that rewards desired outcomes, particularly with respect to quality and affordability.” Applying to Medicaid, Medicare, and private payers, payment innovation will move away from fee-for-service health care (where quantity all too often trumps quality) to pay for quality. In doing so, the hope is that Arkansas will gain a “new, sustainable model of financing” with the help of a multi-payer leadership and support.

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

The Medi-Cal Managed Care system for Shasta County is the COHS Model (County Organized Health System), also known as the Healthy Families Program. This program“administers a capitated, comprehensive, case-managed health care delivery system. This system has responsibilities for utilization control and claims administration and Medi-Cal covered health care services to all Medi-Cal beneficiaries who are legal residents of the county” (Department of Health Care Services, 2009). This model has been shown to be the most efficient Medi-Cal managed care model for improving patient

The negative impacts of healthcare reform to health systems are significant in that health systems are preparing their resources on developing Accountable Care Organizations (ACO) for bundled payments and population-based reimbursement. In this economy the impact to health systems may require healthcare systems to figure out ways to continue to keep positive financial performance due to the cost-reduction of healthcare reform. For some time now, health systems have subsidized their losses from the Medicare and Medicaid systems by contracting with commercial payers for their premium rates. As a result of the healthcare reform, cost shifting will shrink. Another negative impact over the next few years will be the large shift in health plan enrollment. Less people will be covered by highly

The Accountable Care Organization (ACO) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients (McCarty, B., 2016). For example, Medicare Shared Savings Program was created by The Center for Medicare & Medicaid Services to monitor and establish that all ACO’s are meeting the quality performance benchmarks and reduce Medicare spending by certain percentages (H., 2017). The growth of ACO’s from 2011 to 2016 is astonishing, in 2011 there was 64 ACO’s and by 2016 they have risen to 838 in the U.S. (H., 2017).

This paper will discuss what the Accountable Care Organization is, why did Congress include it in their law, benefits and challenges for physicians and patients, and how does the ACO work for patients. We will also identify the quantitative methods in the ACO and reflect on the information provided.

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

Hospitals should be encouraged to participate because improving hospital care is likely to be essential to success (McClellan et al, 2010). Accountable care organizations can be implemented through different payment models. These could include opportunities to share in demonstrated savings within a fee-for-service environment, in which providers took on no new financial risk. They could also include limited or substantial capitation arrangements, in which payments were unrelated to the volume of services provided, to the intensity of service use, or to the frequency of face-to-face meetings, and in which providers took on some financial risk for poor-quality results or failure to control costs (McClellan et al,

In the past few years the American health care system has changed in many ways. First there was the passage of the Affordable Care Act, which is a law that is giving Americans the opportunity to obtain health care. Under this new law, in 2011, the Department of Health and Human Services decided to create Accountable Care Organizations (ACO) to help doctors, hospitals and other providers better coordinate care (AthenaHealth.com). The first idea of an Accountable Care Organization was brought up in 2006 by Elliot Fisher, MD, and now there are over 400 in the United States (Healthcatalyst.com). An ACO’s primary job is to improve health care delivery, performance, and payment. This is done through physicians and

The goal of this policy brief is to support Alabama’s current decision to continue Medicaid Primary Care Parity, as first enacted by congress in 2010 to all states under section 1202 of the Affordable Care Act (ACA). However, as Alabama is facing budget cuts to its Medicaid services, supporting the “Ensuring Access to Primary Care for Women and Children Act” will extend federally funded Medicaid primary care parity without harming the state budget and negate the consequences of limiting Medicaid enrollee access and benefits. The federal government proposed to pay 100% of Medicaid services mandated under section 1202, from 2013 to 2014, which has since expired in December 2014. This program requires certain primary care services to be reimbursed at higher rates equivalent to those rates paid by Medicare for equivalent primary care services. Limited provider participation, limited Medicaid beneficiary access & decreased enrollment of physicians, physician assistants (PAs) and nurse practitioners (NPs) into primary care can be improved through this monetary incentive.

The accountable care organization I researched is called the Physician Organization of Michigan ACO (POM ACO). The POM ACO is a joint venture of the U-M Health System and physician groups around the state, with the aim of improving care for 81,000 Michiganders enrolled in traditional Medicare and slowing the growth of health care costs, according to the announcement by the U-M Health System (Daly, 2013). The group was launched on January 1, 2013 under the Medicare Shared Savings Program. 12 physician organizations from around Michigan came together to take part in a Medicare-sponsored program that strives to improve on the quality of care for traditional Medicare recipients, while also containing cost growth. In 2014, POM ACO expanded to include all the University of Michigan faculty physicians and thousands of other providers from the University of Michigan Health System. The POM ACO is now one of the largest accountable care organizations nationwide. More than 5,700 physicians and other providers are now involved in the POM ACO. Therefore, the POM ACO is organized as a physician-hospital organization. Hence, the patient has more flexibility in where and how their care is delivered. The patient can still use any doctor or hospital that accepts Medicare at any time.

As health care reform in the United States makes drastic changes in insurance policies under the Affordable Care Act, San Francisco developed Healthy San Francisco in 2007, a safety net program aimed to help transition the low income and uninsured Americans as they qualify for various health insurance programs (Katz & Brigham, 2011). Healthy San Francisco is a program only for the uninsured adult citizens within the county limits. Under the program, individuals and families can choose primary care homes and defined specialty care networks, with transparent pricing based on income level (Katz & Brigham, 2011). Children under the age of 18 do not qualify for Healthy San Francisco as they would otherwise qualify for another county run program for children who do not qualify for state or federal health insurance (Katz & Brigham, 2011). As part of the program, a health information program would analyze applicants

SCHIP stands for State’s Children Health Insurance Program introduced in January 24, 1997. The bill is part of the Balanced Budget Act of 1997 which was signed by President William Clinton in August 5, 1997 and became a public law1. The bill allows the States to designate the fund given by the federal government to families that qualifies under certain conditions. However, in September 7, 1997 it received a disapproval bill originating from the House. And in 2007, during the 110th Congressional session, the House introduced the State’s Children Health Insurance Program Reauthorization Act of 2007, H.R. 3963. The bill is introduced by the House Representative John D. Dingell and was placed under House Calendar No. 141 with one general

On April seventh of this year, the California health marketplace announced they would began to reform its contracts with insurers. They plan on applying quality and cost standards on health plans, hospitals, and doctors. Over seven years, Covered California, the name of the exchange, will evaluate poor performing health care providers that do not meet standard core measures, overcharging for services, and other quality metrics. If the health care providers fail to meet these standards, they could have their payments docked at least six percent and/or dropped from the network. If standards are met or exceeded, bonuses would be given. Opponents to the new reform caution that such harsh treatment could lead to a