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Federal government joins quality-over-quantity health care movement with $840M grant program

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The federal government Thursday announced a four-year, $840 million initiative to fund programs that work with doctors to help them “rethink and redesign their practices” in ways that move away from systems driven by the quantity of care delivered, and toward one focused on providing coordinated care that improves the patients' outcomes.

In New Jersey, doctors and hospitals have been working with commercial insurers and Medicare for the past several years to forge new reimbursement schemes that replace the old “fee for service” model with ones that reward health care providers for meeting care quality and patient health benchmarks. Horizon Blue Cross Blue Shield of New Jersey has been a leader in this effort, and now has 500,000 of its members receiving care from “patient-centered” practices that focus on the quality rather than quantity of care.

New Jersey has 11 Medicare Accountable Care Organizations that have been working since 2012 to improve quality and lower the cost of medical care to seniors. Three New Jersey ACOs — Meridian Health, Hackensack University Health Network and Optimus Healthcare Partners — are among a handful nationwide that have so far succeeded in saving Medicare money.

The federal Department of Health and Human Services said those that can apply for the grant money include group practices, health care systems, medical provider associations and others.

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“The administration is partnering with clinicians to find better ways to deliver care, pay providers and distribute information to improve the quality of care we receive and spend our nation’s dollars more wisely,” said HHS Secretary Sylvia Burwell. “We all have a stake in achieving these goals and delivering for patients, providers and taxpayers alike.”

Joel Cantor, director of the Rutgers Center for State Health Policy, said: “Historically, payment for health services by both public and private insurers has rewarded volume over quality or efficiency. This initiative is one of perhaps two dozen in the ACA that is seeking to change that by directly tying payment to efficiency and quality of care.”

Cantor added, “There is a growing body of research that suggests that such strategies can achieve that goal, particularly when the initiatives are focused on patients with complex health conditions and high costs.”

HHS said the program will help clinicians develop strategies to improve the quality of care they provide, while holding down costs. Strategies could include:

  • Giving doctors better access to patient information, such as information on prescription drug use to help patients take their medications properly;
  • Expanding the number of ways patients are able communicate with the team of clinicians taking care of them;
  • Improving the coordination of patient care by primary care providers, specialists and the broader medical community; and
  • Using electronic health records on a daily basis to examine data on quality and efficiency.

HHS said the $840 million Transforming Clinical Practice Initiative will support 150,000 clinicians over the next four years.

Applications will be accepted starting Thursday, and HHS said it anticipates announcing awards in Spring/Summer 2015.

Larry Downs, chief executive of the Medical Society of New Jersey, said he plans to investigate applying for an HHS grant to help the state’s small and solo medical practices. Downs said the society will launch a pilot program in early 2015 to help small practices “coordinate care and work better with their patients, particularly ones that have complex health conditions.”

Downs said that pilot program is being partially funded by the Physicians Foundation. The  timing of the HHS announcement “along with the support and resources we are getting from the Physicians Foundation should help us jump-start this initiative.”

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