Chernew Michael E, Conway Patrick H, Frakt Austin B
Michael E. Chernew ( Chernew@hcp. med. harvard. edu ) is the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts.
Patrick H. Conway was the president and CEO of Blue Cross and Blue Shield of North Carolina, in Durham, when this work was performed.
Health Aff (Millwood). 2020 Mar;39(3):413-420. doi: 10.1377/hlthaff.2019.01410.
The Affordable Care Act promoted payment reforms directly and through the creation of the Center for Medicare and Medicaid Innovation, which it endowed with the authority to introduce Alternative Payment Models (APMs) into Medicare and Medicaid. We conducted a narrative review of these payment reforms, finding that several programs generated modest savings while maintaining or improving the quality of care, but they had high dropout rates. In general, evidence for other APMs is less conclusive, and whether the reforms spurred similar changes in the private sector remains anecdotal. Despite challenges, APMs provide incentives for efficient care provision and offer providers a way to succeed financially in an environment with slowly rising fee-for-service prices. Thus, we consider the Affordable Care Act's payment reforms to be modestly successful, and we encourage both the purging of initiatives that aren't working and the continued development and study of promising ones.
《平价医疗法案》直接并通过设立医疗保险和医疗补助创新中心推动了支付改革，该中心被赋予将替代支付模式（APMs）引入医疗保险和医疗补助的权力。我们对这些支付改革进行了叙述性综述，发现几个项目在维持或改善医疗质量的同时实现了适度的成本节约，但它们的退出率很高。总体而言，其他替代支付模式的证据不太确凿，这些改革是否在私营部门引发了类似变化仍只是传闻。尽管存在挑战，但替代支付模式为高效提供医疗服务提供了激励措施，并为提供者提供了一种在按服务收费价格缓慢上涨的环境中实现财务成功的途径。因此，我们认为《平价医疗法案》的支付改革取得了一定成功，我们鼓励摒弃不起作用的举措，并继续开发和研究有前景的举措。
