Healthcare Changes and the Affordable Care Act: A Physician Call to Action
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Healthcare Changes Reach Main Street: A Call to Action for Physicians provides guidance, examples, and information on processes and time lines for physicians based on the implementation of The Affordable Care Act (ACA) that was established in 2010. This volume focuses on how geriatricians and other healthcare professionals can be engaged in responding to the roll-out of the ACA in their communities, and through this engagement assume leadership roles in local hospitals, healthcare organizations, and medical societies to advance quality improvement and new models of care for older adults. In-depth chapters provide an update on quality improvement efforts at the state level, as well as changes in Medicaid financing and the significant impact this will have for older adults, particularly dual-eligibles. Many elements of the ACA are yet to be rolled out and many healthcare decisions are yet to be made. Healthcare Changes Reach Main Street: A Call to Action for Physicians will guide healthcare decision makers and help them to play a leadership role in advancing quality care for older adults in our changing healthcare environment.
general approach and the contract deliverables; however, the approach to achieving improvement is determined by the QIO taking into account the local health care systems and environment. One way QIOs have worked to identify high performing organizations and to rapidly share effective practices is through learning and action networks (LANs). These LANs are topic-focused and can be statewide, across multiple states, or within a specific community. The idea behind LANs is that they connect
data among Medicare FFS beneficiaries and then determines ACO applicant providers from whom beneficiaries have received the preponderance of their primary care (as determined through a list of “qualifying” Evaluation and Management codes). While the methodology focuses on isolating relationships between beneficiaries and primary care providers, CMS does incorporate beneficiary utilization of certain types of specialists such as nephrologists, oncologists, rheumatologists, endocrinologists,
(ACO) model program frequently asked questions. Available at: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CDMQFjAA&url=http%3A%2 F%2Finnovation.cms.gov%2FFiles%2Fx%2FPioneer-ACO-Model-Frequently-Asked-Questions-doc.pdf&ei=PJpdU8zuPKLa2AW9jIEw&usg=AFQjCNGTzsnZ9K2Qo6Ze15w3-zdrf4xgRw&bvm=bv.65397613,d.b2I. Accessed 27 Apr 2014. 37. Centers for Medicare and Medicaid Services Web Site. Available at:
The net savings from a single payer program are thus estimated at $243 billion, covering everyone with better benefits and spending less overall.18 By shifting from deductibles, co-insurance, and other financial barriers to care to a tax-based model, 95 % of Americans would spend less on health care under this model.19 Single Payer Would Level the Global Business Playing Field for Employers and Labor Employers would be able to book reductions in costs and rely upon other reduced financial
beneficiaries first. Over 14 million beneficiaries (28 % of the Medicare population) enrolled in a Medicare Advantage plan in 2013. Enrollment is concentrated in urban areas and varies widely across the states with 42 % of Medicare beneficiaries enrolled in Oregon, and only 3 % in Wyoming. Two-thirds of beneficiaries chose an HMO model plan . Special Needs Plans (A Form of Medicare Advantage) Special Needs Plans (SNPs) were authorized by Congress in 2003 to focus on specific subtypes of