Delivery System Redesign

The health care affordability crisis is causing unprecedented changes in the health care landscape, the most significant of which is the transition from the current volume-based model to myriad models based on measures of value. This white paper outlines the challenges involved with performing population-level analyses, developing cost accounting and profitability analyses across care settings, evaluating care episodes and integrating quality data. It explores the limitations of targeted software solutions to provide cross-enterprise insights. Finally, it provides advice for healthcare executives regarding how to approach gathering quality and cost-related data and leverage technology and analytical expertise to drive risk-based contract success.
 

The Agency for Healthcare Research and Quality has published the eighth Evaluation Highlight from the CMS-funded CHIPRA Quality Demonstration Grant Program. This Highlight focuses on how Colorado and New Mexico have helped school-based health centers (SBHCs) strengthen their patient-centered medical home (PCMH) features. It describes what motivated these states and SBHCs to adopt the PCMH model and how other states can support SBHCs in becoming medical homes
 

Narrow networks contain a smaller number of providers and in-network facilities than traditional provider networks, typically resulting in lower premiums. This paper assesses the benefits and risks of a range of policy and regulatory options available to federal and state policy-makers on these narrow networks. The development, review and oversight of health plan networks involves trade-offs between premium costs and consumers’ access to and choice of providers. This paper makes clear that there is no current regulatory approach that can satisfy all stakeholders, but with the right balance between consumer choice and cost containment, consumers can receive quality care at an affordable price through narrow networks.

Despite growing evidence documenting the impact of social factors on health, providers have rarely addressed patients’ social needs in clinical settings. But today, changes in the health care landscape are catapulting social determinants of health from an academic topic to an on-the-ground reality for providers, with public and private payers holding providers accountable for patients’ health and health care costs and linking payments to outcomes. With the confluence of sound economics and good policy, investing in interventions that address patients’ social as well as clinical needs is starting to make good business sense.
 

Physicians’ involvement in accountable care organizations (ACOs) will influence how clinicians and patients perceive the ACO model, how effective these organizations are at improving quality and costs, and how future ACOs will be organized. This first-ever survey of public and private ACOs found that 51 percent of ACOs were physician-led, with another 33 percent jointly led by physicians and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs. The broad reach of physician leadership has important implications for the future evolution of ACOs. It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians.