This research provides more evidence that state officials' decisions against expansion adversely affect already disadvantaged residents. While 5.9 million adults with moderate incomes in nonexpanding states qualify for financial assistance to purchase insurance through the new marketplaces, nearly 6.3 million uninsured residents with lower incomes remain ineligible for help because the state's Medicaid program was not expanded. The median income of those ineligible for coverage assistance is less than $800 a month, compared to more than $2,000 a month for those eligible to receive subsidies.
The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models.
These issue briefs explore how local context affects HITECH program implementation as well as providers' incentives and ability to achieve Meaningful Use. These briefs identify the influence that state governments and policies, local grantees charged with implementing particular HITECH programs, health care market and community characteristics, and current health care reform efforts are having on providers' incentives and ability to meaningfully use EHRs and qualify for Medicare and Medicaid incentive payments.