Medicare

Experts agree that the way health care is currently paid for in the United States, especially in the traditional, fee-for-service Medicare program, does not support coordinated care that is high quality and cost-efficient. To address these problems, policy-makers are taking a close look at accountable care organizations (ACOs). This policy brief explores what ACO are, how they compare to previous reform concepts such as Health Maintenance Organizations and Provider Sponsored Organizations, key design and implementation issues, and opportunities and challenges. The authors conclude that ACOs are no real game changers in the short term, but are nevertheless important to try.

This analysis estimates cost burdens of racial and ethnic disparities in a select set of preventable diseases including diabetes, hypertension and stroke. Excess rates of these diseases among African Americans and Latinos relative to whites will cost the health care system $23.9 billion dollars in 2009. Medicare alone will spend an extra $15.6 billion, and private insurers will spend an extra $5.1 billion. Over the next decade, the total cost is approximately $337 billion. Left unchecked, these annual costs will more than double by 2050 as the representation of Latinos and African Americans among the elderly increases.

Growing evidence demonstrates that certain approaches to financing and paying for chronic care coordination for patients are effective not only for improving patient well-being but can also reduce health care spending. However, chronic care approaches should vary for different patient populations and can be carried out effectively by diverse organizations and professionals reflecting the heterogeneity of health care delivery throughout the US. The Report considers the different populations in need of care coordination, summarizes current evidence of effectiveness, describes the various entities that can serve as focal points for coordinating care, and details the possible financing and payment options that can support these approaches.

Emotions are flaring as constituents speak their minds to members of Congress home for August recess. That's to be expected, since health care is both a personal and public issue, but let's not forget to debate the basics:

Because a small fraction of individuals account for a large share of total health expenditures, insurers gain more by excluding high-cost people from coverage than by efficiently managing the care of enrollees. The incentives for insurers to avoid high-cost and high-risk enrollees affect not only the likelihood of health insurance coverage for the high-risk population, but also the cost and accessibility of coverage overall in the small-group and nongroup private health insurance markets. This paper identifies public policies that might address these problems in private health insurance markets more effectively and delineates the advantages and disadvantages of each.