2014 to 2019 (Washington and Lipstein, 2011). While it is premature to judge PCORI’s work, increasing the level of knowledge about comparative effectiveness is critical to building a learning system.

To promote the adoption of health information technologies, the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act, formalized the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services and provided substantial financial incentives for health care providers and hospitals to adopt and use electronic health records. Resources devoted to those programs include $2 billion for programs by the National Coordinator, as well as almost $30 billion in Medicare and Medicaid incentive payments to physicians and hospitals (Blumenthal, 2009; Buntin et al., 2010). Notably, the act encourages not only the adoption but also the meaningful use of such record systems, which is projected to yield savings of $93 billion between 2011 and 2019 (Congressional Budget Office, 2009).

A considerable portion of the ACA is focused on value initiatives. The law established pilot programs to test bundled payments, created value-based purchasing for several common conditions, and reduced Medicare payments to hospitals with high rates of avoidable readmissions and health care–acquired conditions (see Appendix C). One prominent program designed to improve value is the development of accountable care organizations (ACOs). ACOs are voluntary groups of physicians, hospitals, and other health care providers that assume responsibility for specified patient populations. As noted in the final October 20, 2011, regulation for the Medicare Shared Savings Plan, ACOs are responsible for delivering high-quality care as defined by specified quality measures, and share with Medicare any savings that result from better care coordination (Berwick, 2011). These programs are intended to spread the concept of coordinated care beyond Medicare to all payer arrangements.

Another ACA provision focused on value is the creation of the Center for Medicare & Medicaid Innovation. The Center is charged with testing and evaluating innovative payment and delivery system models that could improve care quality while slowing cost growth in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). While the ACA outlines approximately 20 areas the Center could consider at the outset, it gives the Center substantial flexibility to explore different models. Successful models may be extended to a larger patient population with approval by the Secretary of Health and Human Services. The Center’s ultimate goal is to promote the rapid development and diffusion of innovative payment and delivery models that can improve quality and value (Guterman et al., 2010). In its first year, the Center introduced 16 initiatives and stimulated numerous other activities (Center for Medicare & Medicaid Innovation, 2012).

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