JANUARY

What is being done to reduce disparities?
UNITED STATES
There are wide disparities in the accessibility and quality of health care in the U.S. Since 2003, the annual
National Healthcare Disparities Report, released by the Agency for Healthcare Research and Quality, has
documented disparities among racial, ethnic, income, and other demographic groups and highlighted priority
areas requiring action. Federally qualified health centers (FQHCs), which are eligible for certain types of public
reimbursement, provide comprehensive primary and preventive care regardless of their patients’ ability to pay.
Initially created to provide health care to underserved and vulnerable populations, FQHCs largely provide
safety-net services to the uninsured. Medicaid and CHIP provide public health insurance coverage for certain
low-income populations. In addition, the ACA contains a number of provisions aimed at reducing disparities:
subsidies to enable low-income Americans to purchase insurance through the exchanges; efforts to achieve
parity for mental health care and substance abuse services; and additional funding to community health centers
located in underserved communities. There are also a multitude of public and private initiatives at the local and
state levels.
What is being done to promote delivery system integration and
care coordination?
Both the government and private insurance companies are leading efforts to move away from the currently
specialist-focused health system to a system founded on primary care. In particular, the “patient-centered
medical home” model, with its emphasis on care continuity and coordination, has aroused interest among U.S.
experts and policymakers as a means of strengthening primary care and linking medical services more closely
to community services and supports.
Another trend is the proliferation of accountable care organizations (ACOs), networks of providers that assume
contractual responsibility for providing a defined population with care that meets quality targets. Providers in
ACOs share in the savings that constitute the difference between forecasted and actual health care spending.
More than 700 ACOs have been launched by public programs and private insurers, and more than 23.5 million
Americans are enrolled in one (Muhlestein, 2015). Two Medicare-driven ACO programs have been rolled out—
the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program, which together encompass more
than 420 ACOs servicing 14 percent of the Medicare population, or 7.8 million Americans (Muhlestein, 2015;
CMS, 2015b). Patients have reported better care experiences, quality measures have generally improved for the
tracked indicators, and modest savings have been achieved (Blumenthal et al., 2015).
Medicare, Medicaid, and private purchasers, including employer groups, are also experimenting with new
payment incentives that reward higher-quality, more efficient care. One strategy is “bundled payments,” where
a single payment is made for all the services delivered by multiple providers for a single episode of care. About
7,000 hospitals, physician organizations, and postacute care providers participate in bundled payment initiatives
(Blumenthal et al., 2015).
In addition, CMS has supported the development of local programs that aim to better integrate health and
social services. Among these is Massachusetts General Hospital’s Care Management Program, where nurse case
managers work closely with Medicare patients who have serious chronic conditions to help coordinate their
medical and social care. Medicaid ACOs also are implementing programs to integrate primary care and
behavioral health services. Some ACOs are not only trying to integrate clinical and social services but also
exploring innovative financing models, such as cross-sectoral shared-savings models.
What is the status of electronic health records?
The 2009 American Recovery and Reinvestment Act led to significant investment (more than $30 billion)
in health information technology. The legislation established financial incentives for physicians and hospitals
to adopt electronic health record (EHR) systems, under what is known as the Meaningful Use Incentive Program.
As of 2014, 83 percent of physicians used some form of EHR system, and three of four (76%) hospitals had
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