Quality of Care & Delivery Systems

The Affordable Care Act seeks to improve the quality of care and the manner in which that care is delivered, while at the same time reducing costs.

Delivery System Improvements: The law provides enhanced federal funding to states to establish health homes to integrate care for people with chronic illnesses. It establishes the Center for Medicare and Medicaid Innovation to focus on producing better experiences of care and better health outcomes at lower costs through improvement.

Areas of interest under this provision:

Health Homes: Coordinating comprehensive and timely high-quality services and supports for people across the lifespan with chronic illness. See more information on health homes.

Provider-Preventable Conditions Including Health Care-Acquired Conditions: Providing a payment adjustment for health care-acquired conditions (HACs).

Quality Improvement: The law requires the development of a core set of health quality and performance measures for adults to determine the quality of care provided to enrollees. It also provides Federal funding to increase primary care payment rates and for States that provide recommended adult preventive services and vaccinations.

Adult Quality Measures: Recommending a set of core quality measures that can be used for voluntary reporting by states to monitor and improve the quality of care obtained by adults enrolled in Medicaid.

Prevention: Creating the Medicaid Incentives for Prevention of Chronic Diseases Program. This nationwide program will test and evaluate the effectiveness of a program to provide financial and non-financial incentives to Medicaid enrollees of all ages who participate in prevention programs to address at least one prevention goal.

TEFT: TEFT is a four year funding opportunity to states and territories funded by Section 2701 of the Affordable Care Act. CMS will offer $45 million to ten qualified state applicants over four years to test quality measurement tools and e-health in Medicaid long term services and supports.