(卫生经济学课件)Bao ACA payment models ZJU 9dec2015教学讲义.pptxVIP

Payment Reform Models under the Affordable Care ActYuhua Bao, PhDWeill Cornell Medical CollegeZhejiang UniversityHangzhou, ChinaDecember 9, 2015AcknowledgementNIMH Grant support K01 MH090087 R01 MH104200Weill Cornell sabbatical fundAnna Abbasi assisted with literature reviewOverview of current researchIntersection of policy and health care deliveryMental health services research and policyAccess, delivery, payment, outcomesPharmacoeconomicsPrescribing of psychotropic and pain medicationsAging-related health services deliveryHome health careChemotherapy and end-of-life outcomes among advanced-stage cancer patients Research methodologyDesign and conduct of quantitative studiesQualitative interview studies and mixed-method designsGlossaryPayment (vs. reimbursement)Fee-for-service (FFS)AccountabilityFragmentation of care/silo(Chronic) Care managementCare coordinationA chronicle of Affordable Care Act (ACA)March 23, 2010:?President Obama signs the Affordable Care Act (ObamaCare)October 1, 2013:?Open enrollment in the?Health Insurance Market Place begins2014: Medicaid expansion takes effect in states that elected to expand Medicaid coverage Is that all?To be more precise,…It is about quality AND costQuality of health care in the U.S. is poor and inconsistent with the spending growthCurrent provider payment system is a major contributor to rapid cost growth + poor qualityLargely fee-for-service (FFS)Encourages volumeLacks accountability for quality and outcomesLacks incentives for care coordinationA schema of care fragmentationOption 1: Skilled Nursing Facility, $$$Primary care order ($) No health information exchange!Option 2:Home with home health care, $ order ($)OrthopedicsFALLTwo essential elements of good payment designCarrotIncentives for improving quality and outcomes at a lower cost StickAccountability for quality and outcomesMinimum standards to participate (certification, credentialing, etc.)Financial penalty or other consequences if not achieving pre-specifie