Managed Care

 

Health Reform Trying To Get Its Act Together

MANAGED CARE March 2014. © MediMedia USA
Editor's Memo

Health Reform Trying To Get Its Act Together

John Marcille

Some physicists, not to mention authors of science fiction, posit that there are an infinite number of universes with infinite numbers of you and me making infinite decisions that are somewhat different from the ones we’ve made that have gotten us to this point in this particular universe. Some versions of me probably write longer sentences. Some versions of you will not continue reading. And some versions of the Affordable Care Act were rolled out smoothly.

That didn’t happen in this universe, however. Studies released last month that look at two bulwarks of the ACA illustrate just how much work needs to be done. The first asks: How effective are patient-centered medical homes (PCMHs)? Answer: Not very.

In a scathing editorial accompanying the study in the February 26 issue of the Journal of the American Medical Association, Thomas L. Schwenk, MD, notes that “there were no reductions in health care utilization of hospital, emergency departments, or ambulatory care services or total costs, and there was improvement in only 1 of 11 quality measures of chronic disease management, nephropathy monitoring in diabetes.” Advocates of PCMH of course have another view — in this same universe.

Then, the Centers for Disease Control and Prevention asks: How well are accountable care organizations (ACOs) performing in the Medicare pilot? Answer: Meh. They show varying degrees of success and failure.

Michael Millenson, a quality control consultant and a member of our Editorial Advisory Board, supports reform. “The PCMH is not important,” says Millenson (http://tinyurl.com/Millenson-PCMH-blog). “ACOs are a lot more important.... The risk was not very great and the reward was not very great. That’s why you have results that are extreme in neither one direction nor the other. ACOs are going to be a change that’s gradual because we don’t want to destabilize the health care system.”

Meetings

2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015