Milestone: Develop an agenda for achieving quality and efficiency across all public and private payers
Developing an agenda for improvement across payers creates a shared commitment to meeting common goals and supports coordinated action toward the goals. All of which increases the likelihood of reaching the goals and possible effect of specific improvements.
*Full name: Develop an agenda for achieving quality and efficiency across all public and private payers.
*Relevance to the ACA:
The ACA offers resources for improving quality and efficiency. Although it does not require states to develop a cross-payer agenda to use those resources, doing so will allow for more effective implementation of required improvements and more informed choices among optional ones, potentially increase the reach and effect of improvements, and build stakeholder support for specific changes. Some of the resources offered by the ACA include:
Improved measurement to help target and measure improvements, such as:
-- Requirements for commercial insurance plans to report on quality measures (§1001, §1311).
-- Development of new standardized, national measures for adult health quality for Medicaid (§2701).
-- The creation of new standards for data collection in federally-funded health care and public health program as well as in Medicaid and CHIP (§4302).
-- Availability of Medicare claims data to states and other entities developing databases (§10332).
Change provider behavior on both a large scale and a smaller scale, such as the reorganization of certain providers into accountable care organizations (ACOs) (§2706, §3022) or health homes (§2703).
New resources for provider training and support, such as:
-- Establishment of a Primary Care Extension program to assist providers with the implementation of innovations to improve community health (§5405).
-- Grants to promote the use of Community Health Workers (§5313).
Payment changes designed to address imbalances in the current system, such as a requirement that Medicaid agencies pay at least the same amount that Medicare would pay for primary care services with increased FMAP for the increased cost from 2013 until 2015 (HCERA §1202).
Information to help consumers make more informed decisions of plan, provider and treatment, such as:
-- Grants to states to establish or support offices to assist consumers with complaints and queries regarding; to track and collect consumer problems with; and to educate consumers about health insurance (§1002).
-- Requirements that the Secretary of HHS to make public performance information on certain hospitals, rehabilitation centers, and hospice centers (§3001, §3004, §3005, §10322).
-- Grants to establish nonprofit Medical Reimbursement Data Centers which must make health care cost information readily available to the public through an Internet website (§1003, §10101).
-- Requirement that the Secretary to develop a public website providing quality measures tailored to providers, patients, researchers, and states (§3015).less