Delivery System Redesign

There are several different approaches to promoting patient-centered care: creating medical homes, helping patients to become partners in treatment decisions, and instituting payment reforms that enable doctors to be reimbursed for time spent counseling patients about healthy behaviors, for e-mail consultations, and for coordinating care with other providers. Little is known, however, about how health care organizations choose their approach and set goals. In this Commonwealth Fund–supported study, researchers interviewed health plan leaders and providers in Washington State, a leader in patient-centered innovation.

The Centers for Medicare and Medicaid Services (CMS) has finalized memoranda of understanding (MOUs) with Massachusetts and Ohio to test a capitated financial alignment model to integrate care and align financing for people who are dually eligible for Medicare and Medicaid in 2013. This fact sheet compares the key components of the Massachusetts and Ohio demonstrations.

This brief examines the provisions in the ACA oriented towards transforming the American health care delivery system from a system that rewards volume to a system that rewards quality and value. These provisions hold the potential to reduce the rate of cost growth and improve the quality of care delivery through more coordinated care delivery models and reimbursement methods that reward coordinated care.

The Commonwealth Fund Commission on a High Performance Health System analyzed a set of synergistic provider payment reforms, consumer incentives, and system-wide reforms to confront costs while improving health system performance with the goal of holding increases in national health expenditures to no more than long-term economic growth. 

The Affordable Care Act provides new opportunities to integrate care for individuals dually eligible for both Medicare and Medicaid, but states now face challenges in showing how these integrated models improve the quality care. This brief summarizes efforts to develop quality of care measures for Medicare-Medicaid enrollees. It provides guidance to states in developing measurement approaches for proposed integrated programs, including assessment of quality in specific domains of integrated care such as long-term services and supports and behavioral health services. It also describes how performance measures can be shaped by stakeholder input.