Family Medicine for America’s Health (FMAHealth), an initiative sponsored by several primary care associations, released a set of six goals for transforming the U.S. primary care system that includes working with both private and public payers to ultimately end fee-for-service pay.
FMAHealth seeks to “adopt a uniform and simplified model of comprehensive payment that encourages front-end investment in expanded practice infrastructure and technology, rewards Triple Aim goals (better care, better health and lower costs) and supports broad, team-based care.”i
It is widely known that our country spends more on healthcare for less quality than other nations. The Commonwealth Fund sponsored an analysis of cross-national health systems based on Organization for Economic for Co-operative Development health data to place the performance of the U.S. health system in an international context.ii It shows significant spending by the US in all three categories of 1) Out-of-pocket spending, 2) private spending and 3) public spending.
In the report The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations, it reports “the U.S. has fewer hospital beds and physicians, and sees fewer hospital and physician visits, than in most other countries. Prescription drug utilization, prices, and spending all appear to be highest in the U.S., as does the supply, utilization, and price of diagnostic imaging. U.S. performance on a limited set of quality measures is variable, ranking highly on five-year cancer survival, middling on in-hospital case-specific mortality, and poorly on hospital admissions for chronic conditions and amputations due to diabetes.”ii
If the U.S has fewer beds, sees fewer hospital and physician visits, what is the source of our per Capita spending? Findings indicate that although healthcare spending is significantly higher than other countries, we are not delivering quality results. We had the highest rates of hospital admissions for the five major chronic conditions and the greatest number of lower-extremity amputations due to diabetes. Is it possible that Accountable Care Organizations and the goals of the Triple Aim to provide better care at lower cost will shift the cost curve down? CMS projects health spending to grow at an average rate of 5.8 percent from 2012-2022;iii however, in a press release dated 8/25/2015, CMS reported that “20 ACOs in the Pioneer ACO Model and 333 Medicare Shared Shavings Program ACOs generated more than $ 411 million in total savings in 2014, which includes all ACOs’ savings and losses. At the same time, 97 ACOs qualified for shared savings payments of more than $ 422 million by meeting quality standards and their savings threshold. The results also showed that ACOs with more experience in the program tended to perform better over time.”iv
“With chronic disease on the rise amidst an aging demographic and accounting for ever more health care spending, more effective treatment and management in primary care settings, and Accountable Care Organizations, may have the potential to simultaneously improve patient care while preventing the unnecessary use of scarce and expensive resources.“v
i H. J. Jiang, C. A. Russo, and M. L. Barrett, Nationwide Frequency and Costs of Potentially Preventable Hospitalizations, 2006, Healthcare Cost and Utilization Project Statistical Brief #72 (Rockville, Md.: Agency for Healthcare Research and Quality, April 2009).
ii Squires, David. “The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations.” The Commonwealth Fund. 1 July 2011. Web. 11 Sept. 2015. http://www.commonwealthfund.org/~/media/Files/Publications/Issue Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf.
iv “National Health Expenditure Projections 2012-2022 Forecast Summary.” Centers for Medicare & Medicaid Services. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. Web. 11 Sept. 2015. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/downloads/proj2012.pdf.