Delivery System Redesign

The medical home model of health care delivery has been widely embraced over the past decade. Medical home interventions encourage primary care practices to adopt this model, which aims to provide accessible, well-coordinated, patient-centered care and incorporates elements like disease management, patient registries, and electronic health records. This study evaluating the impact of medical home interventions on quality of care found that a group of physician practices participating in a medical home intervention that included a shared-savings bonus program outperformed a comparison group of practices on clinical quality. Patients in the participating practices also had comparatively fewer hospital and emergency room visits.

In the five years since the ACA was passed, the nation's attention has shifted from the law's insurance market reforms and the bumpy rollout of healthcare.gov to the success of the marketplaces in covering millions of previously uninsured Americans. Far less attention has been paid to the parts of "Obamacare" that target problems with how health care is delivered and paid for, many of which become apparent when people receive their insurance card and seek out care.

Medical home initiatives across the United States are demonstrating that multipayer reform, although complex and difficult to implement, is feasible when committed stakeholders negotiate strategies that are responsive to the local context. Seventeen multipayer medical home initiatives launched between 2008 and 2014 all navigated four critical decision-making points germane to any multipayer payment model: convening stakeholders; establishing provider participation criteria; determining payment; and measuring performance. This brief explores the lessons learned from these experiences.

While many health care organizations are motivated to identify and reduce racial and ethnic disparities in the health and health care of their patients, most lack the tools and resources to do so effectively. To identify ways to address disparities more effectively, Aligning Forces for Quality, an initiative of the Robert Wood Johnson Foundation, partnered with Finding Answers: Disparities Research for Change and the Center for Health Care Strategies to work with nine outpatient practices and their communities. This paper shares the lessons learned from these nine organizations in implementing innovative programming to address disparities in their patient populations. It includes concrete recommendations that other health care organizations can use to improve the quality of their health care delivery systems and implement interventions to address inequities in patient care and outcomes.

DSRIP initiatives are part of broader Section 1115 Waivers and provide states with significant funding that can be used to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries. This analysis provides an early look at the impact of DSRIP waivers on Medicaid payment and delivery systems. It is based on interviews conducted with state officials, providers and advocates in three states that have adopted the Medicaid expansion (California, Massachusetts, and New York) and one state that has not adopted the expansion (Texas).  While each of the four programs is different, a number of major themes emerged across the four states that highlight the opportunities and challenges with DSRIP.