The provisions of the Affordable Care Act focus on the delivery, organization, services and payment of the health care apart from catering for insurance reforms (Kemppainen, Tossavainen & Turunen, 2013). On the same note, the objective of the provisions is to address the shortcomings present in the American healthcare system ranging from high cost and inefficiency of the fee-for-service systems to the difference in the health care quality that is delivered to patients from one geographical location to the other (Burwell, 2015).
The Affordable Care Act builds on some of the present reform models in public and private sectors. The law has come up with innovative strategies to address the longstanding problems in the healthcare system. These focuses on testing differing models pertaining to health care services and changes in the reimbursement approach based on quantity to a system based on value and heavily investing in resources that will improve the system (Burwell, 2015).
Citing Burwell (2015), the law briefs on the mentioned approaches and highlights their impacts on specific initiatives and reforms based on the available and reliable data. This is because most of the provisions are still in their early implementation stages.
The Innovative Model
Accountable Care Organizations
The health care providers have formed an entity called an Accountable Care Organization (ACO). Besides, the health care providers ranging from specialists, care physicians and post-acute care providers have agreed to fully ensure that they accomplish the role of providing patients with quality and affordable care. According to Burwell (2015), ACA initiated a program called the Medicare Shared Savings Program in 2012. The objective of the program was to promote ACOs development. It is important to note that if all the participating ACOs not only attain quality benchmarks but also ensure that spending on the attributed patients is below the budget, then they are likely to save, and instead spend on Medicare and Medicaid services.
Additionally, to ensure that ACOs saves more, they can use the two-sided risk model. This encompasses repayment for all the health care losses if the finance allocated to the patients is more than the budget allocation. For example, the 2015 study indicated that the 400 Shared Savings ACOs served approximately 7.2 million of the population insured (Burwell, 2015). Consequently, in the ACOs which are in the shared savings program, the improvements that have been experienced included the 33 quality care ranging from depression and diabetes screening (McWilliams, et al., 2016). This is in comparison with other Medicare providers. Nonetheless, all the organizations were eligible to have a share of the savings by reporting on the data based only on the measures and not considering the actual performance. In early 2014, all the Shared Savings ACOs had to attain the quality standards so that they could share the savings, despite the performance data being unavailable (McWilliams, et al., 2016).
In conclusion, most of the active ACOs have preferred the one-sided risk, and this is a clear indication that the resultant savings can be shared, but they are not subject to paying the incurred losses in the health sector when the spending are above the targets. The Act has supported innovation by covering all the patients to encourage clinicians to deliver health care services in the most innovative ways. Additionally, resources have been devoted to enhancing healthcare infrastructures, for example, information technology systems, which improves coordination among different healthcare providers.
Burwell, S. M. (2015). Setting value-based payment goals–HHS efforts to improve US health care. The New England Journal of Medicine, 372(10), 897-899.
Kemppainen, V., Tossavainen, K., & Turunen, H. (2013). Nurses’ roles in health promotion practice: an integrative review. Health Promotion International, 28(4), 490-501.
McWilliams, J. M., Hatfield, L. A., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2016). Early performance of accountable care organizations in Medicare. New England Journal of Medicine, 374(24), 2357-2366.
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