The Affordable Care Act and the Horizontal Integration of the U.S. Healthcare Ecosystem

Enabling a True Value Based Reimbursement Model

Published: 12 Sep 2016

Key Takeaways

  • Since the enactment of the Affordable Care Act (ACA), approximately 18 million previously  uninsured now have health insurance
  • Approximately 30 million U.S. residents still do not have health insurance
  • Another estimated 31 million lack adequate coverage or are underinsured
  • To date, it has cost the federal government $157 billion to enact the Affordable Care Act
  • As a result of the ACA, the Centers for Medicare and Medicaid Services (CMS) established the new CMS Innovation Center equipped with a range of cost-cutting and quality-enhancing tools
  • CMS Innovation Center’s funding ($1 billion per decade) is established by law (ACA) and as such, is not reviewed annually by Congress
  • The ACA directs the CMS Innovation Center to identify, develop, assess, support, and spread new models that might reduce expenditures under Medicare, Medicaid, and the Children’s Health Insurance Program or CHIP
  • The CMS Innovation Center issues final instructions for the Comprehensive Care for Joint Replacement (CJR) model on November 16, 2015
  • CJR begins as a 5 year demonstration project commencing on April 1, 2016
  • CMS through its Center for Innovation is sanctioning and funding value-based reimbursement pilot projects that are driving traditional health care industry verticals in to collaborative business practices

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