Implementing the Affordable Care Act: Innovations That Improve Health Care Quality and Access

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Health Care Service Delivery in the ACA

Health Care Service Delivery in the ACA

collaborative care team consulting in-patient in bedIn addition to expanding Americans' access to health insurance coverage, the Patient Protection and Affordable Care Act (ACA) 1 promotes a host of health care service delivery models, strategies, and payment structures to improve health care quality and access. These delivery approaches have the potential to improve the health outcomes of millions of Americans, including vulnerable populations such as seniors, those on Medicaid, and ethnic and racial minority groups, while reducing the costs of health care. 2,3,4

The AHRQ Health Care Innovations Exchange has featured a rich collection of profiles on programs at the forefront of health care delivery advancement since 2008. This Web page highlights innovative programs and policies that reflect health care service delivery models and strategies related to the ACA and exemplify some of its key principles, in particular Title III , “Improving the Quality and Efficiency of Health Care”. The page includes a wide range of exemplary, frontline programs; some of the innovations are precursors to the ACA and others illustrate approaches to improving quality and efficiency that support ACA goals. It is intended as a resource for users implementing provisions of the ACA, although it includes innovations that did not arise directly from the Act.

The programs featured here also align with the three aims of the National Quality Strategy : Better Care, Healthy People/Healthy Communities, and Affordable Care. These aims are being used to guide and assess local, State, and national efforts to improve health and the quality of health care in response to the ACA.

Go to the tabs on the left of this section to access information on each of the main topic areas covered on this Web page, including descriptions of the featured innovations and their relationship to the ACA.

 

References:

  1. Healthcare.gov. Health Insurance Marketplace. Available at: https://www.healthcare.gov/marketplace/b/welcome.
  2. Centers for Medicare & Medicaid Services. Affordable Care Act. Available at: http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html.
  3. Hanlon, Carrie and Giles, Brittany. State Policymakers' Guide for Advancing Health Equity through Health Reform Implementation. National Academy for State Health Policy. August 2012. Available at: http://www.nashp.org/publication/state-policymakers-guide-advancing-health-equity-through-health-reform-implementation.
  4. Ross, Janell. Affordable Care Act May Help Close Gap on Health Disparities. National Journal. April 9, 2014. Available at: http://www.nationaljournal.com/next-america/health/affordable-care-act-may-help-close-gap-on-health-disparities-20140409.

Community-Based Care and Prevention

Community-Based Care and Prevention

Elderly people in pilates classThe Affordable Care Act (ACA) includes measures in Title III to encourage and/or evaluate home-based care and community-based wellness and prevention programs. Some of these programs, including health care transition programs for Medicare beneficiaries and home-based primary care teams, have the potential to decrease health care expenditures as well as improve health care outcomes, by enabling individuals to receive health-related services in their homes instead of in a doctor's office, hospital, or other traditional health care delivery setting. Other programs, including community-based and employer-based wellness programs, emphasize prevention and self-management in community settings. The ACA also encourages community-based collaborative networks to promote comprehensive coordinated and integrated health care. In these ways, health care providers can work with communities to promote wider use of best practices that enable healthy living. This page highlights programs that illustrate these health care models.

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Health Care Cost and Affordability

Health Care Cost and Affordability

Physician holding piggy bankControlling health care costs and improving the affordability of quality health care for Americans are two important goals of the Affordable Care Act (ACA). The law includes payment incentives to reduce rates of unnecessary hospital readmission within 30 days of discharge for three main health conditions (heart attack, heart failure and pneumonia) and encourages reductions for other acute and chronic conditions. 1 The ACA also addresses cost by encouraging accountable care organizations (ACOs) as a means for implementing shared savings and other payment mechanisms for managing Medicare patients in Title III , and creates a demonstration project for pediatric ACOs in Title II. ACOs are groups of doctors, hospitals, and other providers who come together voluntarily to give coordinated, high-quality care to their Medicare patients. 2 This page highlights innovative models for decreasing unnecessary hospital readmissions, encouraging ACOs, and using other means to promote affordable care for individuals, families, and the government.

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References:

  1. Centers for Medicare & Medicaid Services. Readmissions Reduction Program. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html.
  2. Centers for Medicare & Medicaid Services. Accountable Care Organizations. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco.

 


Health Care Coordination

Health Care Coordination

Health care coordinators collaboratingThe Affordable Care Act (ACA) promotes care coordination and team-based care as key strategies for providing quality care to individuals that promotes effective communication and coordination, is person- and family-centered, and helps reduce duplicative care. Collaboration among health service delivery systems, including primary care providers, specialists, hospitals, and long-term care facilities, has been shown to result in streamlined care, particularly among dual-eligible populations (those enrolled in both Medicaid and Medicare) and those with chronic diseases 1 . This page highlights innovative models for fostering coordination among health care professionals and delivering team-based health care.

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References:

  1. Thomas, Veronica. What Works in Care Coordination? Activities to Reduce Spending in Medicare Fee-for-Service. AcademyHealth. Based in part on June 24, 2012, panel discussion. Available at: http://www.academyhealth.org/files/RICareCoordination.pdf.

 


Medication Management and Access

Medication Management and Access

Nurse provides medication guidance to patientThe Affordable Care Act (ACA) has provisions aimed at improving access to prescription medications, as well as encouraging proper use of prescription medications. The ACA emphasizes the need to improve medication management for patients with chronic diseases and for patients transitioning between health care settings. This page highlights innovative programs that improve medication prescribing practices, maintain adherence to drug regimens, and promote better health outcomes.

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Payment Strategies

Payment Strategies

Calculator and stethoscopeThe Affordable Care Act (ACA) promotes payment systems that foster the delivery of evidence-based medicine and reward improved health status. The ACA promotes accountability models that apply financial incentives to health services, in order to improve the quality of care and achieve cost savings. Payment models such as shared savings, shared risk, and pay for performance are intended to encourage care coordination and better disease management, and thereby ensure accountability for cost and quality outcomes. This page highlights innovative models focused on applying value-based payments for high-quality, cost-effective care rather than traditional fee-for-service models 1 .

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References:

  1. National Business Coalition on Health. Physician Payment Reform Introduction. Available at: http://www.nbch.org/VBP-Physician-Payment-Reform-Introduction.
  2. Damberg, Cheryl L. et al. Measuring Success in Health Care Value-Based Purchasing Programs. RAND Health. 2014. Available at: http://aspe.hhs.gov/health/reports/2014/HealthCarePurchasing/rpt_vbp_findings.pdf.

 


Person-and Family-Centered Care

Person-and Family-Centered Care

Physician speaking with elderly coupleThe Affordable Care Act (ACA) encourages person- and family-centered care that ensures patients and families are engaged in decisions about their care so that the care received reflects their priorities and goals. Shared decisionmaking models exemplify person- and family-centered care by including patients, caregivers, and providers in health care decisions and considering patient values and preferences in the development of care plans. The patient-centered medical home orients care towards the patient and his or her family. This model for organizing primary care provides comprehensive and coordinated care, offers superb access to care and uses a systems-based approach to quality and safety. 1 Integrated behavioral health care involves a team of behavioral health care providers (encompassing substance abuse, developmental disabilities and mental health) and primary care providers working together with patients and families to provide patient-centered health care. This page highlights innovations that illustrate shared decisionmaking, patient-centered medical homes, and integrated care.

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References:

  1. Agency for Healthcare Research and Quality. Defining the PCMH. Available at: https://pcmh.ahrq.gov/page/defining-pcmh.

 


Tracking Health Care Quality

Tracking Health Care Quality

Clipboard with key metricsThe Affordable Care Act (ACA) has provisions aimed at improving the quality of care and promoting patient safety. The ACA emphasizes public reporting of performance results and alignment of payment with value for virtually all types of providers, from individual clinicians and medical groups to hospitals and long-term care organizations. This page highlights innovative quality improvement initiatives that provide information on the quality of care across settings such as hospitals, skilled nursing facilities, home health agencies, and dialysis facilities for patients with end-stage renal disease. These quality improvement initiatives aim to empower providers and consumers with information that will ultimately lead to improved quality of care.

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Resources

Resources

Agency for Healthcare Research and Quality. The National Quality Strategy. Available at: http://www.ahrq.gov/workingforquality/

Agency for Healthcare Research and Quality. The National Quality Strategy: Using Levers to Achieve Improved Health and Health Care. Available at: http://www.ahrq.gov/workingforquality/reports/nqsleverfactsheet.htm

Centers for Medicare & Medicaid Services. The CMS Innovation Center. Available at: http://innovation.cms.gov.

Healthcare.gov. Health Insurance Marketplace, Affordable Care Act. Available at: https://www.healthcare.gov/marketplace/b/welcome.

Hanlon, Carrie and Giles, Brittany. State Policymakers' Guide for Advancing Health Equity through Health Reform Implementation. National Academy for State Health Policy. August 2012. Available at: http://www.nashp.org/publication/state-policymakers-guide-advancing-health-equity-through-health-reform-implementation.

The White House. About the Affordable Care Act. Available at: http://www.whitehouse.gov/healthreform.

U.S. Department of Health and Human Services. Key Features of the Affordable Care Act. Available at: http://www.hhs.gov/healthcare/facts/timeline.


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