Health affairs
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The Patient Protection and Affordable Care Act makes major changes to the Medicare prescription drug benefit, reducing drug costs for many seniors and increasing rebates and other costs for industry. Although these changes will affect prescription drug costs and pharmaceutical companies' profits, they are unlikely to alter the trends already reshaping the pharmaceutical industry. By participating in crafting health care reform, instead of opposing reform as it did in 1993, the pharmaceutical industry avoided some potential threats to revenues and made accommodations that limited the overall federal costs of reform.
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The Centers for Medicare and Medicaid Services publicly reports so-called process performance at all U. S. hospitals, such as whether certain recommended treatments are given to specific types of patients. We examined whether hospital performance on key process indicators improved during the three years since this reporting began. ⋯ We found that, from 2004 to 2006, hospital process performance improved and was associated with better patient and quality outcomes. Most notably, for acute myocardial infarction, performance improvements were associated with declines in mortality rates, lengths-of-stay, and readmission rates. Although we cannot conclude that public reporting caused the improvement in processes or outcomes, these results are encouraging, since improving process performance may improve quality more broadly.
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The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. ⋯ Further, we propose that the CMS assume responsibility for ACO provisions and develop an ordered system for learning how to create and sustain ACOs. Key steps would include setting specific performance goals, developing skills and tools that facilitate change, establishing measurement and accountability mechanisms, and supporting leadership development.
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The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. ⋯ The lessons include the importance of strong leadership; collaboration and flexibility to foster innovation; receptivity of beneficiaries to care management; and the need for timely data on patients' status. The lessons also highlight pitfalls to be avoided in planning future pilot programs, such as flawed strategies for selecting populations to target when testing payment and service delivery reforms.