While 2014 is ending with evidence of the dramatic gains in health coverage, a more subtle revolution is occurring in how health care is delivered. Using new authorities created by the Affordable Care Act (ACA), in partnership with health care providers, payers, and patients, we have made significant advances in getting better care at lower costs by changing the incentives for the way care is given and putting more information in the hands of health care providers and patients.
Before the ACA, most of the health care system had incentives to do more -- more tests, more procedures, more visits to the doctor meant more money for hospitals and physicians. Now, through a series of innovative approaches, these incentives are changing and health care providers are being paid based on the quality and efficiency -- not quantity -- of the care they give. This practice, known as “value based purchasing,” and other efforts under the ACA to create systems where doctors help coordinate care for patients to avoid hospital readmissions and get patients the care they need on sooner. These systems also are putting in place safeguards to avoid simple mistakes that that have caused many Americans to pick up infections or to suffer other medical complications when they went into a hospital for care in the past.
These types of initiatives are already producing results for patients. For example, Medicare has linked payments to hospital performance on readmissions measures, and the rate of hospital readmissions in Medicare has dropped dramatically, decreasing by nearly 10 percent as compared to the historical average through 2013. This has avoided 150,000 readmissions in 2012 and 2013.
Improvement has also been seen more broadly on patient safety, with an estimated 17 percent decline in hospital acquired conditions from 2010 to 2013, avoiding 1.3 million infections, accidents, and other events that harm patients and saving 50,000 lives. These improvements are estimated to have saved $12 billion in health care spending by avoiding the costs of treating complications.
Even as we have seen these improvements in the quality and safety of patient care, health care spending growth has remained at historically low levels, with new data released in early December confirming that 2011, 2012, and 2013 saw the slowest growth in real per capita health care spending since records began in 1960. Spending growth per enrollee has remained slow across Medicare, Medicaid, and privately insured people, and indications are that growth has remained slow through the first half of 2014 as well, even as the number of people with insurance coverage has expanded dramatically. Leading measures of growth of employer benefit costs show continued slow growth as well, and the prices of health care services have continued to rise at historically slow rates.
Some of the achievements in improving health care quality are summarized in a biennial report to Congress about the Center for Medicare & Medicaid Innovation, which was released today. Consider announcements made in the last 30 days alone:
The Administration has also taken steps to improve the information available on Nursing Home Compare and announced the methodology and timeline for the creation of a star rating system for Home Health Compare, both tools to help patients and families select post acute care providers. The Compare sites empower consumers with information to make more informed health care decisions, encourage providers to strive for higher levels of quality, and drive overall health system improvement.
The Administration is committed to realizing the ACA’s goal of better care through quality improvement, and 2015 will bring even more activity towards those goals. Today’s report to Congress about the Innovation Center details how the Center is testing over 20 new payment and service delivery models and engaging over 2.5 million beneficiaries around the country in an effort to improve quality and reduce costs.
While the details vary, these value-based purchasing systems are pointing the way to smarter purchasing of health care that can lead to better results for patients and taxpayers. These actions underscore the Administration’s commitment to pursuing value-based purchasing in health care across all programs, as well as to promoting the adoption of new payment models that promote comprehensive accountability for health care quality and costs. All of them aim to get more information to health care providers and patients, and to link the federal government’s payments to health care providers to producing better outcomes and more efficient care delivery.