Increasing the quality and decreasing the cost of health care for Americans are two objectives of the Affordable Care Act (ACA).

Strategies that encourage health care providers—doctors, hospitals, and home health agencies—to measure and reward improved care are crucial to the success of health care reform.

Understanding the incentives the ACA offers these health care providers, insurers and employers may help you take advantage of programs that can cut your health care costs.

Wellness Programs

The ACA offers incentives for employers to implement or expand employee wellness programs. Specifically, companies will be rewarded if they reimburse the cost of health club memberships, health education fees, the purchase of exercise equipment and the like for their employees.

This means you can get in shape and improve your health for free, or for less than you’ve been paying. Businesses will also be reimbursed up to half the cost of programs that help their employees quit smoking.

Pay for Performance

The ACA provides the following “pay for performance” initiatives. The goal is to motivate your health care providers to provide better care for less cost to you.

  • Hospitals. The Hospital Value-Based Purchasing program will make payments to more than 3,500 U.S. hospitals that meet or exceed performance standards. Likewise, the Centers for Medicare & Medicaid Services can apply a 1 percent payment penalty to hospitals whose readmission rates for patients with specified conditions are higher than they should be.

  • Doctors. Physicians will receive incentives for participating in the Physicians Quality Reporting System. Participating physicians will report data indicating they are using medical treatments and practices that improve patient care. This translates to better care and fewer treatment mistakes for patients.

  • Home health agencies. More than 100 home health agencies nationwide are sharing close to $15 million in incentives from a two-year Medicare Home Health Pay for Performance program because they demonstrated better care for less cost for their patients.

Lower-Cost Medicare

The ACA includes numerous incentives for better care at reduced costs in Medicare:

  • Primary Care Incentive Payment program. Doctors and primary care practitioners who are aligned with accountable care organizations are receiving financial incentives if they provide high-quality care and prevention strategies for patients.

  • Medicare Advantage Plan bonuses. Medicare Advantage Plans will receive financial incentives if they attain at least a three-star rating on a five-star health care quality rating scale. Medicare Advantage Plans are also required to spend a minimum of 85 percent of their profits on medical care or activities to improve quality. Plans that spend less may lose their contracts.

For more information, visit the U.S. Department of Health and Human Services.

× Alternate Text