North Carolina Institute of Medicine: Interim Report
The Patient Protection and Affordable Care Act offers the potential to improve healthcare access, quality, and population health, while reducing escalating health care costs, but it creates new challenges for the state, families, businesses, health care professionals, and organizations.In order to implement the new law, the North Carolina Department of Insurance and the North Carolina Department of Health and Human Services asked the North Carolina Institute of Medicine to convene workgroups to examine the new law and gather stakeholder input to ensure that the decisions the state makes in implementing the ACA serve the best interest of the state as a whole. The effort is being led by an Overall Advisory Group, which is chaired by Lanier M. Cansler, CPA, Secretary, North Carolina Department of Health and Human Services and G. Wayne Goodwin, JD, Commissioner, North Carolina Department of Insurance.
Bundled payment, or episode-based paymen systems, allow reimbursement for multiple providers to be bundled into a single, comprehensive payment that covers all of the services involved in patient care. The goal of the bundled payment approach is similar to that of the IHI Triple Aim objectives of improving population health, boosting the patient care experience, and reducing cost.
Accountable Care Organizations
Under the Patient Protection and Affordable Care Act (PPACA) of 2010, Medicare providers, including physician groups and hospitals, will soon have the option to form accountable care organizations (ACOs) to improve quality and efficiency. ACO participants may share financial gains generated from improved clinical and economic performance, provided that quality goals and patient safeguards are met. Through future regulations, the Centers for Medicare & Medicaid Services (CMS) must implement the ACO option no later than January 1, 2012.
Prometheus Payment Model
The PROMETHEUS Payment model seeks to ignite a transformation in health care payment by challenging the way providers and insurers conduct business – moving away from unit-of-service payment to episode-of-care payment.
Reform and Employers
Under the Affordable Care Act, beginning in 2014 employers with at least 50 full-time employees will have to provide "qualified" health insurance coverage to their full-time employees and their dependents. The employer must pay on average at least 60 percent of health care expenses and will be assessed if the employees' premiums are considered unaffordable relative to their household incomes. If either of these two conditions is not met, the employer must pay a $3,000 annual assessment for each employee who obtains government-subsidized coverage through an exchange. The law also provides small companies tax credits to offer health insurance to their employees.
Massachusetts Healthcare Reform
The Division of Health Care Finance and Policy seeks to improve health care quality and contain health care costs by critically examining the Massachusetts health care delivery system and providing objective information, developing and recommending policies, and implementing strategies that benefit the people of the Commonwealth.
The Commonwealth Fund
Analysis of provisions in the PPACA that will affect providers’ financial incentives, the organization and delivery of health care services, investment in prevention and population health, and the capacity to achieve the best health care and health outcomes for all.
Even after the passage of a contention health care reform law, the United States may face no more important domestic policy challenge than the continuing reform of our health care system. Brookings experts deliver new ideas and offers policy solutions to improve health care both at home and globally.
Realizing Health Reform's Potential
The Commonwealth Fund has launched a new series of Fund issue briefs that examines the way the Affordable Care Act of 2010 (ACA) will benefit different populations and groups, as well as improve insurance coverage and change the delivery of care.