We would like to think we’re getting quality care every time we see a doctor or go to the hospital for an emergency. But that may not always be the case.
What should we expect from our healthcare?
One goal of healthcare reform is to improve the quality of care in the U.S. But what does that mean? According to the Agency for Healthcare Research and Quality, an agency of the U.S. Department of Health and Human Services, the Institute of Medicine (IOM) has developed one of the most influential analytic frameworks for quality assessment of the U.S. healthcare system, which includes the following six aims for the U.S. healthcare system:
- Safe – Avoiding injuries to patients from the care that’s intended to help them
- Effective – Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit
- Patient-centered – Providing care that’s respectful of, and responsive to, individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
- Timely – Reducing waits and sometimes harmful delays for both those who receive and those who give care
- Efficient – Avoiding waste, including waste of equipment, supplies, ideas, and energy
- Equitable – Providing care that doesn’t vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
How does the ACA address quality of care?
The ACA addresses concerns about quality of care in both direct and indirect ways, including the following:
- Accountability from insurance companies – The ACA requires insurance companies to spend 80%–85% of your health insurance premium dollars on healthcare and quality improvement or give you a rebate.
- Emphasis on prevention – The ACA emphasizes prevention by investing in wellness. By staying well, we may be able to avoid or lessen the impact of many diseases and their accompanying costs.
- Creation of health homes – The ACA provides an option to state Medicaid programs to provide and coordinate care in your community as an alternative to institutional care. A health home is a designated provider or team of providers who coordinate the patient’s treatment, which includes services, transitions to and from the hospital, support services, and referrals to other community services.
- Improvements in community health centers – The ACA also provides for improving the quality of our care by strengthening the nation’s network of community health centers and testing new methods for delivering services, for example, coordinating care among physicians and community resources. (Visit the Center for Medicare & Medicaid Services (CMS) Innovation Center for more information on its mission to improve quality of care and reduce rising healthcare costs.)
- Changes to how healthcare providers and hospitals do business – By insisting on accountability and providing incentives, the intent of the ACA is to reward healthcare providers who successfully coordinate patient care, improve quality, stress prevention, and reduce the number of hospital admissions. For example, patient records are to be recorded electronically to reduce paperwork, costs, and medical errors and to make it easier to share health information with you and your other providers.
- Data collection to address disparities – Collecting data on race and ethnicity can help us identify disparities and improve the quality of care for everyone in the U.S.
- Attracting and training primary care physicians in every community – Providing more training opportunities for primary care health professionals and offering incentives for practice in underserved areas may attract more primary care physicians to serve these communities.
- Strategy initiatives and funding – The ACA calls for the creation of administrative bodies and funding to study and improve healthcare in the U.S., for example:
- Funding for comparative effectiveness research to determine which treatments provide the best quality of care
- Creating a preventive and public health fund to promote preventive and public health programs
- Creating a national prevention, health, promotion, and public health council (National Prevention Council) to develop a national and public health strategy
- Creating a CMS innovation center to test new healthcare payment and delivery system models, for example, accountable care organizations that provide incentives for doctors to work together to better coordinate your care and value-based purchasing, which is a program that rewards hospitals with financial incentives to improve quality of care
What can you do to improve your quality of care?
Get involved! As a medical care consumer, just like in other areas of your life, you may have to shop around, ask questions, and tell providers that you expect the best. The more you know about the product, the better off you’ll be.
Government websites and others offer tools to help you find quality care, for example:
- HealthCare.gov – Tools to help you compare the quality of care provided by hospitals, nursing homes, home health, and dialysis facilities in your area
- Medicare.gov – Medicare tools for comparing physicians and medical plans
You can also participate in improving the quality of your care by learning as much as you can about treatment options available to you and discussing them with your doctor.