Delivery System Redesign

In an effort to improve both the affordability and quality of health care in America, key health care stakeholders from the insurance, hospital, physician, business, and consumer sectors—America’s Health Insurance Plans (AHIP), Ascension Health, Families USA, the National Coalition on Health Care, and the Pacific Business Group on Health—worked together to reach consensus about what is needed to control costs and improve quality. This blueprint highlights the group’s five recommendations for aligning incentives to transform care delivery and strengthen the infrastructure needed to achieve improved savings and health outcomes.

England, France, Germany, the Netherlands, and Sweden spend less as a share of gross domestic product on hospital care than the United States while delivering high-quality services. All five European countries have hospital payment systems based on diagnosis-related groups (DRGs) that classify patients of similar clinical characteristics and comparable costs. These European systems, discussed in more detail in the article, suggest potential innovations for reforming DRG-based hospital payment in the United States.

This brief examines several case studies from the AF4Q communities and the care-across-settings initiatives that they are undertaking. Their experiences demonstrate that the weakest link in a patient’s care is often the transition from one setting to another, but our health care system does not have consistent systems or funds in place for establishing care transitions programs.

This article describes the Center for Medicare and Medicaid Innovation’s new rapid-cycle evaluation approach, which will assess its success at reducing expenditures and preserving or improving the quality of care provided to beneficiaries of Medicare, Medicaid, and the Children’s Health Insurance Program.

The accountable care organization (ACO) model of health care delivery is rapidly being implemented under government and private-sector initiatives. The model requires that each ACO have a defined patient population for which the ACO will be held accountable for both total cost of care and quality performance. This study examines the two major methods of defining, or attributing, patient populations to ACOs: the prospective method and the performance year method.