ACP: Health care innovation in the Affordable Care Act

A guest column by the American College of Physicians, exclusive to

by John Tooker, MD, MBA, MACP

The Patient Protection and Affordable Care Act (PPACA) has important provisions – improved access, safety and quality among them – that have the real potential to improve health and health care and, lower costs.

Two recent reports remind us of the urgent need to improve safety and quality: A report from the American College of Asthma, Allergy and Immunology (ACAAI) 2010 Annual Scientific Meeting on the national state of the care of patients with asthma, a bellwether chronic illness that can and should be managed well for most patients in ambulatory settings, and the HHS Inspector General’s report on adverse hospitalization events of Medicare beneficiaries. Coincident and timely with the release of these reports, the Center for Medicare and Medicaid Innovation (Innovation Center) was established this month.

At the 2010 ACAAI scientific meeting, Meltzer and colleagues from the University of California at San Diego reported the largest and most comprehensive U.S. asthma survey since 1998, asking patients (adults and adolescents) how well they perceive their asthma is controlled. As a pulmonologist, I found the results disappointing. Though there have been advances in asthma care over the past decade, asthma unfortunately remains poorly controlled with many patients describing frequent asthma symptoms, using rescue medications for chronic symptom control and not using maintenance controller medications as prescribed – with substantial adverse impacts on patient well being, productivity and health care costs.

The HHS Office of The Inspector General is required by law to report to the Congress on the incidence of never events among Medicare beneficiaries, the payment for services in connection with these events, and the CMS processes to identify the events and deny payment. The recently released 2010 report examined the records of Medicare patients discharged from hospitals in October 2008 – 1 in 7 patients experienced an adverse event (13.5%), and remarkably, 44% of the events were viewed as preventable. The related additional costs to Medicare just for the study month were substantial – estimated at $324M.

On the same day as the HHS Inspector General released his report, CMS Administrator Dr. Don Berwick and Dr. Richard Gilfillan, Acting Innovation Center Director, announced the new Center for Medicare and Medicaid Innovation, established in the 2010 PPACA. According to Gilfillan, the Center will identify and test care models that provide beneficiaries with a seamless care experience, better health and lower costs.  Aimed at improving care coordination, the first initiatives of the Innovation Center are:

  • An eight-state multi-payer medical home demonstration
  • A new medical home demonstration involving Federally Qualified Health Centers (FQHCs)
  • A new state plan option allowing states enhanced Medicaid funds for placing certain beneficiaries in health homes
  • An opportunity to improve care for beneficiaries eligible for both Medicare and Medicaid, also known as “dual eligibles”

The evidence is clear that we need to perform much better on both quality and safety. In response to that need, we have a well resourced national opportunity – the Innovation Center – to improve the care and health of each patient, of the population at large, and lower costs, through innovations in care delivery and payment. Success, as Drs. Berwick and Gilfillan have identified, will require the active participation and leadership of doctors and other key stakeholders.

John Tooker is Associate Executive Vice President of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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