Discussion Paper: Health Care Reform and Medicare in the US

This discussion paper examines the ongoing health care reform efforts in the United States, particularly focusing on the role of Medicare and the implementation of alternative payment models (APMs). The paper highlights the shift towards value-based care, where payment is tied to the quality of care rather than the quantity of services provided. It discusses the Health Care Payment Learning and Action Network's initiatives to increase the adoption of APMs and the potential benefits of reducing health care costs and improving patient outcomes. The paper also addresses the impact of Medicare, including its role in medication development and providing coverage for those who would otherwise lack it. It also touches on the importance of federal support and the need for collaboration between public and private sectors to achieve comprehensive health care reform, referencing relevant research and policy changes, including the Affordable Care Act.

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DISCUSSION PAPER
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DISCUSSION PAPER
Health care reform in response to increased health care costs in United States has set a
goal of achieving better care in terms of quality to achieve healthier status among population.
The health care learning and action network is drawing an attention of private, public as well as
non-profit sectors to give importance to the quality of care rather than the quantity of care
provision to people. This network has set up a goal of combining 30 percentage of Medicare
service fee payments with quality of care through alternative payment models and then increase
this by 50 percent (Health Care Payment Learning and Action Network, 2017). Alternative
payment models (APM) provide benefit in reducing health care costs and provide better quality
care through common payment services for payers and providers. This network draws payers,
providers, consumers to increase the transitioning to APM by making the operational changes
viable. This Network acts a convening body which works for joint implementation of new
payment models with quality care delivery. The initiatives taken include collaborative
approaches and developing financial models to ensure quality care delivery, thereby creating
implementation guidelines (Health Care Payment Learning and Action Network, 2017). These
initiatives will in turn lead to improved health care benefits through quick transitioning to
alternative health care payments.
The policy of Medicare is involved in providing coverage to those who do not have
coverage which acts as an advantage of the Medicare. In many cases the Medicare does work
well. As a result of several ageing adults who is able to get some coverage otherwise who won’t
be able to afford it. This Medicare program was created for 9 millions older adults who didn’t
have health coverage. The Medicare costs quite less little every month where Medicare enrollees

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DISCUSSION PAPER
are most of the time qualified for free Part A of the policy however it must pay a very small
amount from their own pockets every month for Part B.
MA designs offer recipients an elective method to get Medicare benefits from the plans
which are sold by private insurance agencies that agrees with the Centers for Medicare and
Medicaid Services (CMS). The Medicare has prompted the medicine developments. The
initiation of Medicare made an enormous market for medication organizations. All of a sudden, a
large number of Americans approached solutions they wouldn't have had something else. At the
point when pharmaceutical organizations saw the undiscovered potential in the Medicare
showcase, they started putting billions of dollars in the improvement of medications custom-
made explicitly for seniors (Obama, 2016).
The population with low income status are deprived of such delivery programs which are
in contrast to the existing policies. The health care cost reduction can be achieved not only
through private insurers solely, federal support services and inputs are needed in association with
the private sector involvement. By evaluating the results of the policies it is seen that to make
progress through policy changes, the policy providers should incorporate implementation
programs involving health insurance market places. Through delivery system reform and taking
necessary actions to reduce prescription drug costs would provide federal financial assistance
through incorporation of coordination instead of competition (Baicker & Levy, 2013). The
partisanship between local and federal governments are still present, however, the reform efforts
are achievable at the federal level as is evidenced by the reduction in the health care payment
share and decline in the rate of uninsured people.

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DISCUSSION PAPER
References
Baicker, K., & Levy, H. (2013). Coordination versus competition in health care reform. New
England Journal of Medicine, 369(9), 789-791.DOI: 10.1056/NEJMp1306268
Health Care Payment Learning and Action Network | Center for Medicare & Medicaid
Innovation. (2019). Retrieved from https://innovation.cms.gov/initiatives/Health-Care-
Payment-Learning-and-Action-Network/
Obama, B. (2016). United States health care reform: progress to date and next
steps. Jama, 316(5), 525-532.doi: 10.1001/jama.2016.9797
Patient-centered Primary Care Collaborative | PCPCC’S 2018 Accomplishments (2019).
Retrieved from https://www.pcpcc.org/initiative/delivery-system-transformation-
initiatives-dsti