The Shift Of The Affordable Care Act ( Aca )

1100 Words Dec 3rd, 2014 5 Pages
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Economics As the shift for HCOs is made to a PCMH model, the financial aspect also has to make a transition to accommodate to the changes. In recent years, there have been implementations of different payment and reimbursement options, health insurance programs, and the establishment of the Affordable Care Act (ACA). Between May 2009 and April 2012, one of the initial PCMH pilot programs was conducted in Colorado, appropriately named The Colorado Multipayer Patient-Centered Medical Home Pilot. More than 100,000 patients within sixteen internal medicine practices participated in the experimental PCMH model, using six different health plans (Harbrecht & Latts, 2012). When the pilot was conducted, Harbrecht and Latt (2012) state that the monthly care management fee, that was used to pay physician fees, was calculated by “multiplying the number of […] patients in each practice by the per member per month (PMPM) case management fee (pg. 2011).” To avoid discrepancy and to remain consistent throughout the financial process, each plan supported the same payment models, payment schedules, and administrative procedures adhering to the standards set forth by the National Committee for Quality Assurance (NCQA). To be able to arrive to a PMPM fee, other pilot programs’ PMPM fees were compared, the cost estimates for enhanced care were analyzed, and the ability of each plan to recoup their initial investments, explain Harbrecht and Latt (2012). Each health…

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