Why Baylor Health Care System Would Like to File for Medicare Shared Savings Accountable Care Organization Designation but Cannot

Abstract

National focus on health care reform is being driven by recognition of the simultaneous needs to improve quality, reduce costs, and increase access. Multiple stakeholders in our society, from governmental authorities to payers, employers, and patients, are raising their voices in the call for answers to these problems, in what the Institute for Healthcare Improvement termed the Triple Aim: “better care for individuals, better health for populations, and lower per capita costs.”1 The Centers for Medicare and Medicaid Services (CMS) subsequently adopted this aim, in particular as the mission of the newly formed Center for Medicare and Medicaid Innovation.2 Congress, too, has weighed in on the issue, with one of the primary goals of the 2010 Patient Protection and Affordable Care Act (PPACA) being substantial reduction in the number of Americans without health insurance, to be achieved largely through expansion of the state Medicaid programs and creation of health benefit exchanges.3 Most health care experts recognize that the problems of cost, quality, and access must be solved. The unsustainable costs and the relentless rates of increase in costs,4 in particular, are driving health care organizations to find solutions.