Health and Disability

So far, the 2016 change getting the most attention is that Medicare will pay clinicians to counsel patients about options for care at the end of life. The voluntary counseling would have been authorized earlier by President Barack Obama’s health care law but for the outcry fanned by former Republican vice presidential candidate Sarah Palin, who charged it would lead to “death panels.” Hastily dropped from the law, the personalized counseling has been rehabilitated through Medicare rules.

But experts who watch Medicare as the standards-setter for the health system are looking elsewhere in the program. They’re paying attention to Medicare’s attempts to remake the way medical care is delivered to patients, by fostering teamwork among clinicians, emphasizing timely preventive services and paying close attention to patients’ transitions between hospital and home. Primary care doctors, the gatekeepers of health care, are the focus of much of Medicare’s effort.

Patrick Conway, Medicare’s chief medical officer, says that nearly 8 million beneficiaries — about 20 percent of those in traditional Medicare — are now in “Accountable Care Organizations.” ACOs are recently introduced networks of doctors and hospitals that strive to deliver better quality care at lower cost.

“Five years ago there was minimal incentive to coordinate care,” said Conway. “Physicians wanted to do well for their patients, but the financial incentives were completely aligned with volume.” Under the ACO model, clinical networks get part of their reimbursement for meeting quality or cost targets. The jury’s still out on their long-term impact.

Still, a major expansion is planned for 2016, and beneficiaries for the first time will be able to pick an ACO. Currently they can opt out if they don’t like it.