Yesterday marked a major milestone in our progress to create a high-performing health care system for the United States. Provisions in the Affordable Care Act have now taken effect, such as the requirement for insurance plans to allow young adults to join or stay on their parents' plan until age 26, and a ban on insurance plans' practice of "rescinding" coverage after individuals get sick.
There are additional health care reforms are coming in the next months and years that I am looking forward to. These are designed to improve how our care is organized, delivered, and paid for. Here are 10 big changes yet to come:
1. Health Insurance Exchanges and New Market Rules
Health insurance exchanges will give us the ability to compare and choose among health plans, while setting the rules for fair competition.
2. New Nonprofit Plan Choices
Innovative, nonprofit cooperatives have transformed health care delivery into mission-driven, patient-centered, and value-enhancing systems that are accountable to patients and consumers.
3. Health Plans will be required to meet minimum medical loss ratios and requests for Insurance Premium Increases will be reviewed.
4. New changes to encourage primary Care and disease prevention
These include increased primary care payment rates under Medicare and Medicaid, preventive services without patient cost-sharing, and support of community and employer prevention and wellness programs. The act also increases funding for community health centers and the National Health Service Corps. These provisions start to focus our health system on primary care, encourages doctors o enter primary care specialties and get us ready for more fundamental payment reforms.
5. Stimulate Innovation
The Accountable Care Act establishes a Center for Medicare and Medicaid Innovation, which will allow us to test innovative payment methods for the personal medical home. Medicare reimbursement rates are decreased by 1 percent for hospitals that have high rates of readmission for certain conditions. Individual states will be allowed to test integrating Medicare and Medicaid-covered health services provided to the poor on Medicare.
6. Accountable Care Organizations
These are collections of health care providers that can formally assume responsibility for the cost and quality of health care given to a defined group of patients. Research has shown that ACOs have the potential to reduce growth in health care costs and improve patient outcomes by introducing incentives for efficient use of resources and encouraging greater coordination of care.
7. Independent Payment Advisory Board
This board has authority to identify areas of waste and opportunities for improving the quality of care for Medicare beneficiaries. The board’s recommendations will take effect in years when Medicare costs are projected to exceed predetermined rate-of-increase targets—unless Congress passes legislation to override those recommendations, in which case Congress would be responsible for achieving the same level of savings.
8. Quality Improvement and Public Reporting
The law requires public reporting of physician quality and patient experience through a "Physician Compare" Web site for Medicare beneficiaries. It also makes Medicare data available for pooling with data on provider performance from other payers—an important step toward creation of an all-payer provider performance database. (Privacy will be protected.) Reports by health plan will be available to the public.
9. Medicare Private Plan Competition
Plans must compete on value, quality and service, and will no longer receive extra funds.
10. A Tax on High-Premium Health Insurance Plans
The new law imposes a 40 percent excise tax on health plans with premiums in excess of $10,200 for individual policies and $27,500 for families, to take effect in 2018. This will be adjusted in case of unexpected increases in medical costs prior to 2018.