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Health Care Reform Timeline

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PBGH Strategy 2011 2012 2013 2014 2015 What PBGH is doing

Engaging Consumers

A Medicare Physician Compare website will launch in January.

 

 

 

 

 

 

 

The Medicare Physician Compare website will have information on physician performance and patient experience

 

Public reporting of Medicare hospital readmission rates begins.

 

Exchanges are open to individuals and small employers;

Information is available about health plan quality for plans in the exchange.

 

Eventually, exchanges could also be a way to share information about provider performance.

 

Sharing suggestions and best practices for consumer information web sites, based on our own experience with the CA Office of the Patient Advocate website and the PBGH Health Plan Chooser  tool for employees.

Helping Medicare to develop robust and meaningful measures of physician performance that the public can readily understand and access.

Sharing lessons learned and expertise about how to develop exchanges that work, based on our own experience with PacAdvantage.

Serving as an advocate and health information technology expert to ensure providers use health information technology in ways that make information understandable, meaningful and accessible to consumers.

Continuing to “push the envelope” in California and nationwide to urge for publically available data on cost and quality, including Medicare data. Our own work with the CA Physician Performance Initiative and Reference Pricing, among other projects, helps these efforts.

Paying for Value

A new Center for Medicare and Medicaid  Innovation will test reforms that reward providers based on the quality of services provided, not volume of services delivered.

 

Health plans that spend less than 85% of premiums on medical care will have to offer rebates to members.

Accountable Care Organization demonstrations begin for Medicaid, CHIP, Medicare (public coverage programs).

 

Hospitals in Medicare Readmission Reduction Program may get decreased payments for excess readmissions .

Hospital Value Based Purchasing Program will be established; will incentivize enhanced quality outcomes at acute hospitals.

 

Medicare Payment Bundling Pilot must be established.

Independent Payment Advisory Board can start submitting fast track policies to slow Medicare spending.

 

Measures of efficiency will be added to the Medicare Hospital Value Based Purchasing Program.

Medicaid and CHIP Pediatric Accountable Organization (ACO) pilot ends in 2016.

The Medicare 5-year Payment Bundling Pilot will come to a close in 2017 unless it is extended.

The Value-based Physician Modifier that adjusts Medicare fee-for-service payment to physicians for quality and efficiency of care is implemented for specific physicians in 2015 and applied to all physicians in 2017.

 

The Medicare Hospital Readmissions Reduction Program will be expanded to include four additional conditions.

 

Hospitals in top quartile of hospital acquired infections will get a 1% reduction in Medicare payments.

 

For every year when a Medicare covered facility and professional does not achieve meaningful use of health information technology (use technology in a robust way to improve patient experience and care) Medicare payment will be reduced.

 

Supporting the new CMS Innovation Center.

 

Developing recommendations for well functioning  ACOs based on input from purchasers.

 

Continuing to advocate for the expansion of programs that tie payment to outcomes and value, and align payment structures between the public and private sector, through our work with the Catalyst for Payment Reform.

 

Sharing lessons learned from our own Paying Hospitals for Value project in California.

 

Sharing lessons learned from our reducing hospital readmissions work with the California Quality Collaborative.

 

 

 

 

 

 

 

 

Redesigning Care

National strategy to improve health care quality will be submitted to congress in January.

 

A national strategy for health prevention and promotion will be developed.

 

Patient Centered Outcomes Research Institute is created to compare effectiveness of treatments and health strategies.

ACO demonstrations begin for Medicaid, CHIP, Medicare (public coverage programs).

 

National strategy to improve health care quality will be updated.

National strategy to improve health care quality will be updated.

National strategy to improve health care quality will be updated.

Advocating for robust measures of treatment outcomes and patient experience to improve the quality of care, through our leadership as co-chair of the Consumer-Purchaser Disclosure Project.

 

Developing recommendations for well functioning  ACOs based on input from purchasers.

 

Serving as an advocate and health information technology expert to ensure providers have the performance information and systems in place to improve their care

 

 

Sharing lessons learned from our reducing hospital readmissions work with the California Quality Collaborative and other CQC projects that engage providers to redesign and improve care.

 

Helping demonstrate the importance of comparative effectiveness through the success of our own projects; PBGH projects including the California Joint Replacement Registry, Better Cardiac Care and Better Maternity measure treatment outcomes and engage providers and consumers to make better treatment decisions.

Advancing policy

 

 

 

 

 

Participating in all the activities listed above, serving as a core leader and expert advisor.