Improving Care for People with Medicare

By Don Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services. Crossposted from HealthCare.gov

If you or a loved one has ever had the unfortunate experience of having a chronic or serious illness, you’ve experienced the frustration of our fragmented health care system. Just when you are feeling your worst, there you are in the doctor’s office or hospital room, repeating the same information time and time again, sitting through the same medical test more than once, and trying to track down lost or unavailable medical charts. These are all aspects of our current health care system we could each do without.

This can be a particular problem for the more than half of Medicare beneficiaries with five or more chronic conditions such as diabetes, arthritis, and kidney disease. These patients often receive care from multiple physicians and in multiple sites. A failure to coordinate care can lead to patients not getting the care they need or receiving duplicative care. This lack of coordination also increases their risk of suffering medical errors, such as receiving prescriptions for medications that ought not to be taken together. It can also cause complications that lead to needless hospital stays. Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days – a readmission many patients could have avoided if their care outside of the hospital had been better coordinated.

Improving coordination and communication among physicians and other providers and suppliers will help improve the care Medicare beneficiaries receive, while also helping lower costs. Numerous studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time.

Thanks to the Affordable Care Act, the Department of Health and Human Services (HHS) today released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs are designed to create and support a team of health care providers who treat individual patients by working together across care settings.

Over the last months, CMS has conducted extensive outreach to patient advocates, doctors, nurses, hospitals, health plans, employers, and other interested stakeholders to hear their thinking about the best way to shape this effort. We will continue to seek feedback on the proposed rules released today so that the final rules reflect the broadest consensus on how to improve care for people with Medicare and to provide a model for private payers to draw upon. We look forward to working with patients and care providers to build the most patient friendly and cost-effective health care system achievable

Under the proposal, ACO teams of doctors, hospitals and other health care providers and suppliers working together would coordinate and improve care for patients with Original Medicare. ACOs would have to meet high quality standards in five key areas:

•Patient/Caregiver Experience of Care
•Care Coordination
•Patient Safety
•Preventive Health
•At Risk Population/Frail Elderly Health

An ACO will be rewarded for providing better care and investing in bettering the health and lives of patients. ACOs are not just a new way to pay for care. They are a new model for the organization and delivery of care. Accountable Care Organizations are designed to lift the burden of fragmented and disconnected care from patients, while improving the partnership among patients, doctors, hospitals and other providers of care in making health care decisions.

To read more on this, check out the fact sheet. You can also read my blog at the New England Journal of Medicine.