We’re excited to launch our own blog. This gives us a chance to comment on new developments we feel are important in the rapidly changing world of US healthcare. We won’t confine ourselves just to clinical issues. Social, political, economic and even spiritual topics are having an increasing influence on the way American healthcare is evolving. Open discussion of these fascinating relationships is important if we’re going to find our way to a better, more integrated approach to the care of our sickest and most vulnerable citizens.
One example is the interface between politics and healthcare delivery. Bipartisan rancor over Obamacare has obscured the fact the Affordable Care Act (ACA) actually did very little to change American health care delivery. The ACA dealt mostly with insurance reform. Two important domains were left almost untouched: delivery system and payment reform. That vacuum did not result from neglect, but from political necessity. Voters and their representatives had little tolerance for direct Federal intervention into how healthcare is provided or paid for.
If the ACA didn’t mandate any specific changes in healthcare delivery, it nevertheless threw the door wide open to reform by creating the Center for Medicare & Medicaid Innovation (CMMI). We’re excited to have had hands-on experience with the design and implementation of one of the larger projects funded by Round 1 of CMMI’s Health Care Innovation Awards. Now we’re even more energized by our growing partnerships with leading health plans, provider organizations and health systems across the country to change delivery and payment structures for care of people with advanced illness.
From our vantage point, there’s no doubt that substantive and robust change has begun at all levels of American healthcare. Certain innovational structures, like Accountable Care Organizations, are followed closely in the media and the medical literature. Other new developments are less well known, although their impact on current clinical and business practices promises to be profound. A prime example is CMS’s new Medicare Spending Per Beneficiary (MSPB) metric embedded in its hospital value-based purchasing (HVBP) program. In coming years, MSPB-related penalties may come to influence hospital utilization as much or more than current CMS penalties for high readmission rates. We’ll discuss potential effects of MSPB on utilization, costs and innovation in an upcoming post here.
We look forward to an open and fruitful relationship with our readers. Although we have no shortage of opinions, we don’t intend this blog to be a one-way street. Please feel free to add your comments so we can learn together. Discussion and debate are the royal road to understanding and action.