BACKGROUND A key consideration in designing pay-for-performance programs is determining what entity the incentive should be awarded to—individual clinicians or to groups of clinicians working in teams. Some argue that team-level incentives, in which clinicians who are part of a team receive the same incentive based on the team’s performance, are most effective; others argue for the efficacy of clinician-level incentives. This study examines primary care clinicians’ perceptions of a team-based quality incentive awarded at the clinic level.
The Supreme Court ruling on the Affordable Care Act (ACA) allowed states to opt of the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.
Providing increases in Medicaid reimbursements for primary care, a key provision of the Affordable Care Act (ACA), raised Medicaid payments to Medicare levels in 2013 and 2014 for selected services and providers. The federally funded increase in reimbursements was aimed at expanding access to primary care for the growing number of Medicaid enrollees. The reimbursement increase expired at the end of 2014 in most states before policymakers had much empirical evidence about its effects.
In today’s health care system, fee-for-service (FFS) remains the dominant payment model for both public and private payers. Retrospective, individual payments for each office visit, procedure, and other health service can and often does result in higher utilization—leading to more, though not necessarily better, care. BPC’s leaders believe that providing incentives to move to organized systems of care will both improve quality and slow the rate of growth in health care cost, as well as improve accountability and facilitate the transition to population health.
The accountable care organization (ACO) model is currently being pursued by private insurers, as well as federal and state governments. Little is known, however, about the prevalence of private payer ACO contracts and the characteristics of contract structures or how these compare with public ACO contracts.
Study Design and Methods
Cross-sectional analysis of the National Survey of Accountable Care Organizations (n = 173) on ACO contracts with public and private payers and private payer contract characteristics.
Under the Affordable Care Act, Medicaid fees for primary care services were increased to Medicare levels from January 1, 2013 through December 31, 2014. This paper uses data from the Urban Institute’s 2014 survey of Medicaid physician fees to estimate how large a reduction in Medicaid primary care fees will occur on January 1, 2015, if the ACA’s Medicaid primary care fee bump expires.
PURPOSE In 2006, Illinois established Illinois Health Connect (IHC), a primary care case management program for Medicaid that offered enhanced fee-for-service, capitation payments, performance incentives, and practice support. Illinois also implemented a complementary disease management program, Your Healthcare Plus (YHP). This external evaluation explored outcomes associated with these programs.
Since the creation of the Medicare and Medicaid programs in 1965, the public has provided tens of billions of dollars to fund graduate medical education (GME), the period of residency and fellowship that is provided to physicians after they receive a medical degree. Although the scale of government support for physician training far exceeds that for any other profession, there is a striking absence of transparency and accountability in the GME financing system for producing the types of physicians that the nation needs.
