Encouraging physicians and hospitals to come together to form Accountable Care Organizations (ACOs) to serve fee-for-service Medicare patients is a key cost control and quality improvement feature of the Affordable Care Act (ACA).
The National Quality Strategy is the first overarching policy designed to lead federal, state and local efforts in improving the quality of Americas health care.
An accountable care organization (ACO) is a group of health care providers (for example, primary care physicians, specialists and hospitals) operating as a single entity with collective responsibility for patient care.
Groups and individuals across the country are working to improve the quality of care at the local level by designing and implementing changes in the way health care is organized, delivered and paid for in their community.
Comparative effectiveness research (CER)—studies that compare health care treatment options to inform decision-making—is alternately described as the best or worst idea in the ongoing dialogue about how to fix American health care.
Increasingly, the federal government has stressed the value of health information technology (HIT) in helping providers to share information quickly, monitor compliance with treatment guidelines and measure and improve their own performance. In 2009, Congress approved $29 billion for a national HIT infrastructure.
The quality of health care that many Americans receive is inconsistent and often poor. Patients do not always receive the type of known interventions and procedures that are proven to work, which can result in poor outcomes.
Why It Matters
Compared to health care in other wealthy countries, care in the United States is high-cost and low-quality. We spend 50 percent more on health care per capita than any other country, but the United States has shorter life expectancies and worse infant mortality rates than most other wealthy countries.
Adult patients in the United States receive only about half of the care recommended for their condition—such as giving people with diabetes the right battery of blood tests and eye and foot exams, so that costly and devastating complications are avoided. Nearly 30 percent of the care delivered each year is for tests, procedures, hospital stays and other services that may not improve people’s health, and in some cases can actually harm the patient. Public and private quality improvement and payment reform efforts may help dramatically improve care nationwide.
There is a strong public and private investment aimed at getting more value for the money spent on health care—meaning higher quality care provided more efficiently. Increasingly, the government is rewarding providers who give tests, procedures and services that are known to work—a move toward paying for quality of care rather than quantity of services provided.
Policy Context
A core purpose of the Affordable Care Act (ACA) is to increase value in health care through innovations in payment, technology and other tools that have been shown to improve quality and reduce unnecessary spending. The primary vehicle to accomplish health system change is expanded authority given to the Secretary of Health and Human Services to undertake pilot programs related to health care delivery and organization.
Choosing the right doctor or hospital is one of the most important health care decisions consumers will ever make, yet they have little information to guide the decision.