Lowered Healthcare Costs? Thanks, ObamaCare

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Tara Culp-Ressler: How The Obama Administration Is Getting Serious About Lowering Health Costs

The Obama administration unveiled an ambitious plan on Monday that will make historic changes to the way that doctors get paid. The ultimate goal is to tie more of doctors’ payments to the quality of care they provide, hopefully driving down the trillions of dollars that the U.S. currently spends on health services every year. The reforms are targeted at Medicare, the government program that provides coverage for Americans over the age of 64. Most Medicare providers currently get paid through what’s called a “fee for service” system. They’re paid a flat free for every test or procedure they perform, regardless of whether those services actually improve their patients’ health. Now, the administration wants to shift the program so that more of its payments are tied to health outcomes.

Essentially, that means providers will be rewarded for keeping their patients healthy, and penalized for unnecessary services that don’t advance that goal. Proponents of payment reform are encouraged by the move — which they see as a serious step toward creating a health care system that’s based on the value, rather than the sheer volume, of services. The Affordable Care Act has been slowly moving in this direction over the past few years. The health law created alternative payment models — called “Accountable Care Organizations,” or ACOs — to incentivize providers to work together to improve patient care and cut down on costs. So far, there’s been some evidence that ACOs are successfully improving the quality of health care for Medicare patients. Some are also starting to generate cost savings. If ACOs save enough money, the participating providers earn bonuses, a goal that about a fourth of of them hit last year.

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How the Obama Administration is getting serious about lowering health costs thkpr.gs/3615915

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ThinkProgress (@thinkprogress) January 27, 2015

1st clear indication we're leaving fee-for-service in much of healthcare. As I said in 2009, it's the right direction nyr.kr/1zqEwRq

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Atul Gawande (@Atul_Gawande) January 27, 2015

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Rock climb ✓ Work out ✓ #GetCovered ✓ A healthy lifestyle includes getting health coverage: healthcare.gov http://t.co/Jwxu3Bo4mt

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The First Lady (@FLOTUS) January 29, 2015

If you need health insurance, find a plan that's right for you right now: ofa.bo/g2Y7 #GetCovered

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Barack Obama (@BarackObama) January 26, 2015

McAllen, Texas Saved $20M On Healthcare?! Thanks ObamaCare

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NYT: A Health Care Success Story

IT may have been the most influential magazine article of the past decade. In June of 2009, the doctor and writer Atul Gawande published a piece in The New Yorker called “The Cost Conundrum,” which examined why the small border city of McAllen, Tex., was the most expensive place for health care in the United States. The article became mandatory reading in the White House. President Obama convened an Oval Office meeting to discuss its key finding that the high cost of health care in the country was directly tied to a system that rewarded the overuse of care. Five years later, the situation has changed. Where McAllen once illustrated the problem of American health care, the city is now showing us how the problem can be solved, largely because of the Affordable Care Act that Mr. Obama signed into law in 2010.

The problem was that doctors in McAllen were responding to reimbursement incentives in the American health care system that rewarded activity rather than value. The more procedures and visits a doctor billed, the more he got paid. The Affordable Care Act was designed to change that. One of its provisions created the Medicare Shared Savings Program, which rewards doctors for keeping their patients healthy. Participation in the program requires primary care doctors to create networks, called accountable care organizations, or A.C.O.s, to better coordinate patient care. These networks are reimbursed for delivering high-quality care below a baseline of historical Medicare costs. In 2012, doctors in McAllen formed the Rio Grande Valley Accountable Care Organization Health Providers, and signed up for this experiment. The early results are in, and they are stunning: From April 2012 to the end of 2013, the Rio Grande Valley A.C.O. saved more than $20 million from its Medicare baseline. These changes didn’t just save money; they also improved patients’ health. From 2012 to 2013, the number of patients achieving control of their diabetes rose 11.8 percentage points. The number receiving vaccinations rose 12.2 percentage points.

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