Payment Reform Action Plan:
Meeting the New Medicare Payment Reform Target
There has been much addressed about the Affordable Health Care Act (ACA). The law was passed to allow preventive care more accessible and affordable to the population. Today, most health care payments are made on a fee-for-service basis, which rewards overuse, promotes waste and inefficiency, and pays little attention to accountability for quality of care. The ACA offered the opportunity to test alternative payment models that pay health providers based on the value of care rather than volume.
This change in the law of health care allows payments to healthcare providers on the quality of care, rather than the quantity of care. The models implemented under
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In addition, CAP believes that HHS should promote payment reform among Medicare Advantage plans, some of which pay providers on a fee-for-service basis despite being paid by the Medicare program through capitation. CAP, having previously recommended a goal of having 75 percent of Medicare payments made through alternative models by 2022, believes the secretary’s commitment to a specific target represents a significant milestone in transforming payment incentives and moving providers as well as private payers away from fee-for-service. (Zeke Emanuel, 2015). The Center for American Progress calls on HHS to consider policy actions for better attainment of the new imbursement renovation objectives. The ACA has made it attainable for the administration to expand reform of the Medicare program without additional legislative actions. “Price and quality transparency is a critical building block as we double down and get serious about rising health care costs and improving the quality of the care,” explains Ginny Prostakes, Director of Health Benefits for GE. “But purchasers and consumers need to come together and push plans and providers to make it happen” (Kohleriter-Perelman, 2015). The ACE program, Medicare’s Acute Care Episode, replaces fee-for-service with discounts and fixed payments for a bundle of services of cardiac and orthopedic procedures. The ACE program will expand