Earlier this year, the U.S. Department of Health and Human Services (HHS) announced the success of a three-year timeline for shifting Medicare alternative payment models to focus not on the volume of patient care, but on the value providers delivered to patients. This was primarily due to the fact that the healthcare system was organized around providing care for more people, as opposed to quality care in general.
The Patient Protection and Affordable Care Act (ACA) put a number of financial incentives in place for hospitals and other healthcare providers to ensure quality care with affordable options for patients. This comes at a time when most seniors have to pay $104.90 each month for their Medicare, illustrating how medicare alternative payment models are needed to curb rising prices.
Specifically, by the end of 2016, the HHS aims to transition 30 percent of traditional (fee-for-service) Medicare payments to alternative payment models that impact care quality, such as Accountable Care Organizations (ACOs) or bundled payment arrangements. By 2018, the goal is to transition 50 percent of payments.
HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. This is the first time in the history of the Medicare program that HHS set explicit goals for Medicare alternative payment models and value-based payments. These regulations refocused how revenue impacted our healthcare organizations in the U.S., forcing a change in priorities centered around delivering quality care moving forward.
The Impact on Patients
According to HHS, these new models have been put to work in Medicare specifically, and helped prevent 50,000 patient deaths in hospitals and 150,000 preventable hospital readmissions since 2010.
It’s safe to say that medicare payment reform benefits the consumer by ensuring healthcare providers are more accountable for their actions, and therefore, help patients to get better, instead of being a system that keeps people in cycles of constant treatment. Not to mention, Medicare alternative payment models reduced the number of uninsured patients and made insurance more affordable for many, saving on average approximately $300 per participating beneficiary per year.
According to The New York Times, from October 2013 to October 2014, 8.7 million people joined Medicaid enrollment. Around 7.5 million were from 27 states that increased Medicaid eligibility overall, which expanded budgets to allow for improved electronic health records (EHRs), wearable technology, heart rate monitors and other clinical advancements.
The Impact of Healthcare Providers
The ACA has driven many new patients and insurance customers into the ecosystem. Medicare alternative payment models also issue payments to providers with accountable care organizations and care management fees. According to the Commonwealth Fund, these fees give providers the opportunity to receive an additional five percent bonus each year from 2019 through 2024 if a measurable amount of their revenue is accounted to these new models.
The Commonwealth Fund explained that healthcare providers who participate in these models would also be eligible for payment adjustments, with up to $500 million in funding available every year from 2019 to 2024, especially if they deliver quantifiable high-quality care to patients.
In addition, advancements in mobile technology from Samsung have ensured that every doctor has access to the same files, which significantly reduces issues when serving their patients. Mobile security platforms, such as Samsung KNOX, a manageable, on-device solution, help healthcare systems better validate the identities of individuals accessing protected health information (PHI) regularly, which ensures sensitive healthcare records are secure and all stakeholders are held accountable for their actions. As accessibility to patient records increases through the proliferation of mobile technologies, Samsung is at the forefront with its KNOX platform.
Despite its issues, healthcare payment reform benefits both patients and healthcare providers alike, offering a greater budget to spend on further correcting challenges facing the healthcare system.