Transforming Medicare's Payment Systems: Progress Shaped By The ACA

The Affordable Care Act promoted payment reforms directly and through the creation of the Center for Medicare and Medicaid Innovation, which it endowed with the authority to introduce Alternative Payment Models (APMs) into Medicare and Medicaid. We conducted a narrative review of these payment refor...

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Bibliographic Details
Published inHealth affairs (Millwood, Va.) Vol. 39; no. 3; pp. 413 - 420B
Main Authors Chernew, Michael E, Conway, Patrick H, Frakt, Austin B
Format Journal Article
LanguageEnglish
Published United States The People to People Health Foundation, Inc., Project HOPE 01.03.2020
Subjects
Accountable care organizations
Aged
Childrens health insurance programs
Cost control
Dropping out
Fee-for-Service Plans
Fees & charges
Government programs
Health care policy
Humans
Incentives
Initiatives
Innovations
Medicaid
Medicare
Patient Protection & Affordable Care Act 2010-US
Patient Protection and Affordable Care Act
Pay for performance
Payment systems
Payments
Physicians
Population
Prices
Primary care
Private Sector
Purging
Quality
Quality of care
Reforms
United States
United States
United States > US
Accountable care organizations
Payment
Costs and spending
Health policy
Traditional Medicare
Medicaid services
Medicare Advantage
Affordable Care Act
Fee-for-service
Quality of care
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Summary:The Affordable Care Act promoted payment reforms directly and through the creation of the Center for Medicare and Medicaid Innovation, which it endowed with the authority to introduce Alternative Payment Models (APMs) into Medicare and Medicaid. We conducted a narrative review of these payment reforms, finding that several programs generated modest savings while maintaining or improving the quality of care, but they had high dropout rates. In general, evidence for other APMs is less conclusive, and whether the reforms spurred similar changes in the private sector remains anecdotal. Despite challenges, APMs provide incentives for efficient care provision and offer providers a way to succeed financially in an environment with slowly rising fee-for-service prices. Thus, we consider the Affordable Care Act's payment reforms to be modestly successful, and we encourage both the purging of initiatives that aren't working and the continued development and study of promising ones.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2019.01410