House of Representatives Pass Historic Health Care Reform Legislation. California Physician Groups Meet with Congressional members to Discuss the Importance of Accountable Care Organizations

By Don Crane
Thursday, November 12, 2009

Representatives from California’s physician groups were in Washington D.C last week just before the landmark House vote on HR 3962, the Affordable Health Care for America Act.  While HR 3962 still makes significant revisions to Medicare Advantage, we are very pleased that the legislation makes health care more accessible and affordable for millions of Americans by enhancing coverage, promoting preventive care and improving delivery of care through Accountable Care Organizations.  The bill is now headed to the Senate where a more intense debate will take place and where our advocacy efforts must now be focused.


During our visit last week, we met with Senators Feinstein and Boxer and other members of Congress to discuss recommendations for strengthening health care reform legislation and accelerating the development of Accountable Care Organizations.  As physician groups, we are accountable for the costs and quality of the care we deliver and we know that the delivery model and payment reform are the keys to successfully transforming our health care system.  That is why we think the provisions in HR 3962 relating to Accountable Care Organizations are so important.


As we have reported in the past, making ACOs a permanent part of health care reform will help control costs by moving beyond the old model of fee-for-service charges by doctors, and instead advancing “outcome based” medicine, physician networks and the adoption of health information technology.  The implementation of a Medicare ACO system will improve care for seniors by providing low cost care, through a network of physicians, who will use the latest technology to provide researched-based health care to their patients. The Congressional Budget Office estimates the savings of a national ACO “pilot program” at $2.3 billion.

As witnessed in the recent House vote, the majority of Congress is now embracing the ACO concept and is looking to California’s physician groups, who have been practicing within an ACO model for the past 20 years, for their input and expertise about how to best implement ACO’s throughout the nation.  As seniors who are enrolled in Medicare Advantage and are receiving comprehensive health benefits as a result, you understand the importance of ACO’s.


We are back in Washington this week educating legislative and federal government staff about the importance of Health Information Technology, including electronic medical records, and its critical role in health reform legislation. We will also continue with our advocacy efforts to protect the Medicare Advantage model and Accountable Care Organizations as the Senate considers legislation over the next several weeks. 

We sincerely appreciate you sharing your stories with Congress about how important Medicare Advantage is to the quality of your health.  Please continue to share your experiences with our nation’s leaders at www.americansforcoordinatedhealthcare.org.

 

Coordinated Care Facts

In 2007, Medicare Advantage saved seniors nearly $90 per month or $1000 per year in out of pocket costs. An estimated savings of approximately $7 billion annually. Additionally, compared to traditional Medicare, Medicare Advantage plans can reduce out-of-pocket costs by up to $4,000 annually for patients with the highest healthcare needs.

  • Comprehensive Care: Patients receive integrated treatment plans, and expert case management and disease prevention strategies for the chronically ill.
  • Cost-Effective Care: Integrated medical groups are able to support investments in advanced healthcare information technology, tracking patient follow-through on treatment plans and patient outcomes, and helping to uncover health problems before they become catastrophic.
  • Accessible Care: Efficiencies within the coordinated care delivery model mean better healthcare for more seniors, including:
    • lower out-of-pocket costs
    • increased health services such as dental care, vision care and preventive care
    • reduced hospitalizations
    • increased prescription coverage
    • higher overall satisfaction rates
    • greater value for the premium dollar than any other healthcare delivery system

What’s At Risk

If Medicare reforms dismantle incentives for coordinated care, seniors will experience significant increases in out of pocket costs - at a time when many seniors have seen their retirement account’s decline by over 40 percent in value — and decreased quality of healthcare.

Downloadable Resources

California Association of Physician Groups Report: From the Point of Care - The Experience of California Physicians in the Medicare Advantage and Traditional Medicare Programs

The Organized Health Care Delivery System

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