U.S. Senate Passes Sweeping Healthcare Reform Legislation
By Donald Crane
Friday, January 8, 2010
Greetings and Happy New Year! Just before Christmas, the U.S. Senate passed the Patient Protection and Affordable Care Act (H.R. 3590). We are now one step closer to the final passage of the most sweeping health reform legislation since the enactment of Medicare. The current healthcare reform proposal provides an extraordinary opportunity to make a very real difference in the lives of millions of people. This comprehensive bill package addresses major areas in need of change, including expanding coverage to nearly all Americans, eliminating various unfair insurance practices, and beginning to transform our dysfunctional delivery system.
Both the House and Senate bills will begin to modernize an antiquated fee-for-service payment model -- one that has been entrenched for decades and now threatens to bankrupt our current health care system --into a higher quality, more accountable system of care. The existing fragmented structure makes it very difficult for patients to receive optimal care because the fee-for-service model pays physicians for treatment regardless of whether the care provided is appropriate, beneficial, or even warranted. Additionally, within the fee-for-service model, patients are obliged to self navigate through a maze of specialists who frequently have no connection to each other, creating a climate ripe for medical errors, duplicate treatments, waste, and sub-standard outcomes.
Healthcare reform offers us a unique opportunity to transition from this disorganized approach to one that is more affordable, comprehensive, and coordinated through the establishment of Accountable Care Organizations (ACO).
Making ACOs a permanent part of health care reform will help control costs by moving beyond the old model of fee-for-service, and instead advancing “outcome based” medicine, physician networks, and the adoption of health information technology. The implementation of an ACO system will improve care for patients by providing lower cost care, through a network of physicians, who will use the latest technology to provide evidence-based health care to their patients. The Congressional Budget Office estimates the savings of a national ACO “pilot program” at $2.3 billion.
California’s physician groups are among the few throughout the country that have been practicing within an ACO model for the past 20 years. The 150 multi-specialty groups that comprise CAPG represent the backbone of California’s delivery system and are in fact the very “Accountable Care Organizations” that the House and Senate bills have tasked the Center for Medicare and Medicaid Services (CMS) to spread across the country. We are the experts who can demonstrate how the accountable care model can work for the rest of the nation and we are eager to get the process started.
A final healthcare reform package could be passed by Congress and sent to President Obama in the next few weeks. Time is of the essence. Please send your message to Congress letting them know you support healthcare legislation that includes Accountable Care Organizations by visiting, www.americansforcoordinatedhealthcare.org.
Coordinated Care Facts
In 2007, Medicare Advantage saved seniors nearly $90 per month or $1000 per year in out of pocket costs. An estimated savings of approximately $7 billion annually. Additionally, compared to traditional Medicare, Medicare Advantage plans can reduce out-of-pocket costs by up to $4,000 annually for patients with the highest healthcare needs.
- Comprehensive Care: Patients receive integrated treatment plans, and expert case management and disease prevention strategies for the chronically ill.
- Cost-Effective Care: Integrated medical groups are able to support investments in advanced healthcare information technology, tracking patient follow-through on treatment plans and patient outcomes, and helping to uncover health problems before they become catastrophic.
- Accessible Care: Efficiencies within the coordinated care delivery model mean better healthcare for more seniors, including:
• lower out-of-pocket costs
• increased health services such as dental care, vision care and preventive care
• reduced hospitalizations
• increased prescription coverage
• higher overall satisfaction rates
• greater value for the premium dollar than any other healthcare delivery system
What’s At Risk
If Medicare reforms dismantle incentives for coordinated care, seniors will experience significant increases in out of pocket costs - at a time when many seniors have seen their retirement account’s decline by over 40 percent in value — and decreased quality of healthcare.
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