One of my pet peeves when it comes to debate over the Affordable Care Act is that 99.9 percent of the chatter centers on insurance. To be sure, expanded coverage is the financial linchpin of the law. I get it. And the disastrous launch of the government's enrollment website only adds fuel to the fire (Did you ever imagine that the president would have to go on national TV and do his best Billy Mays impersonation to sell the marketplaces?). However, there is so much more in the 900-plus-page piece of legislation that's pushing the field farther down the transformation highway.
Those of you running hospitals or working with them on the vendor/consulting side are well aware of this; you are knee-deep in efforts to dramatically change the way care is delivered. Unfortunately, much of that news goes unreported and unnoticed on the 24-hour news channels, Facebook and elsewhere.
During the past couple of weeks, reports have come out that detail some of the efforts to improve care and transform delivery. They didn't get a lot of press.
On Oct. 21, JAMA Internal Medicine published a research letter that analyzed efforts by hospitals and health systems to reduce unplanned readmissions. The researchers — hailing from Yale, Yale–New Haven, and the University of Illinois–Chicago — studied data from 2010–2012 for the Hospital to Home National Quality Improvement Initiative. Nearly 600 hospitals enrolled in the program, sponsored by the American College of Cardiology and Institute for Healthcare Improvement, with the aim of improving care for cardiovascular patients.
The study found that 30 percent of hospitals began partnering with other hospitals to better manage this patient population, up from the baseline of 22 percent. Hospitals regularly calling patients post-discharge improved from 62 to 71 percent. Additionally, a growing number of hospitals were evaluating patients for the risk of readmission.
However, the researchers also found that there is room for improvement, noting, "… many hospitals are not implementing recommended strategies that have been shown to be associated with lower hospital risk-standardized readmission rates."
Also this week, the Henry J. Kaiser Family Foundation issued a report detailing the "historic" changes facing Medicaid programs. While much of the report digs into the financial constraints looming over state Medicaid budgets, there's some interesting detail around efforts to transform care delivery.
For example, the report points out "new care coordination efforts were under way in 25 states in FY 2013 and 33 states in FY 2014 (40 states in one or both years.) Over a third of states (21) planned to implement Medicaid health homes in FY 2014, established by the ACA, up from six states in FY 2013. A common focus of the health home initiatives is coordinating care for persons with serious mental health conditions. Twelve states in FY 2013 and nine in FY 2014 were implementing or expanding patient-centered medical homes. Six states in FY 2013 and eight states in FY 2014 were implementing or expanding accountable care organizations in Medicaid."
The report provides more analysis of what individual states are doing to use Medicaid dollars to drive delivery system reform.
Lastly, the Patient-Centered Outcomes Research Institute unveiled an initiative aimed at accelerating the pace of, you guessed it, research around patient-centered care. PCORI was created as part of the ACA.
Through the Pipeline to Proposal Awards, institute leaders "recognize that it can be difficult for patients and other health care stakeholders to develop partnerships and to get involved in research. This funding opportunity is available to individual or small groups of patients, other stakeholders, and researchers who have an idea for a potential research project but need assistance and guidance to build it."
Are these topics as sexy as the debate raging over the exchanges/marketplaces? Probably not. Are they equally as important? Without a doubt.
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