Delivery System Redesign

The growing adoption of electronic medical records and advances in health information technology are fueling an explosion of new health data. Expectations are high that new data resources will guide the transformation of the health care industry and positively influence population health. There have been challenges and opportunities at every turn, and progress has been slow, but mounting evidence suggests that better use of data is moving health care in the right direction.
 

Case studies of three U.S. regions that ranked relatively high on the Commonwealth Fund’s Scorecard on Local Health System Performance, 2012, despite greater poverty compared with peers, revealed several common themes. In these communities, multi-stakeholder collaboration was an important factor in achieving community health or health system goals. There were also mutually reinforcing efforts by health care providers and health plans to improve the quality and efficiency of care, regional investment and cooperation to apply information technology and engage in community outreach, and a shared commitment to improve the accessibility of care for underserved populations. The experiences of these regions suggest that stakeholders can leverage their unique histories, assets, and values to influence the market, raise social capital, and nudge local health systems to function more effectively.

This report highlights leading states’ approaches to support community-based prevention initiatives by bridging health care delivery and public health systems. It examines various mechanisms – both previously existing and those created through health reform – that states can leverage to implement sustainable community-based prevention programs. They include Medicaid waivers, federal grants, accountable care and medical home models, pooled funding, and new federal requirements for nonprofit hospitals. The report includes opportunities and lessons from featured states (California, Maryland, Massachusetts, Minnesota, North Carolina, Oregon, Texas, and Vermont).
 

As states develop managed care programs for individuals who are dually eligible for Medicare and Medicaid or who use long-term services and supports, it is important for states to engage medical, behavioral health, and home- and community-based service providers, as well as hospitals and nursing facilities. Providers can serve as an important channel for communication with state policymakers and administrators about how the managed care program is faring, and they can help highlight best practices and identify problems before they occur. This brief, developed through support from The Commonwealth Fund and The SCAN Foundation, provides tips to help states engage providers in designing, implementing, and overseeing a managed care delivery system for individuals with complex care needs.
 

States are increasingly turning to Medicaid managed care as a key strategy to manage costs and encourage innovation in health care delivery. This report examines health care providers’ perspectives on the role of managed care in improving health services for low-income adults in four communities: Milwaukee, WI; Oakland, CA; Seattle, WA; and Washington, D.C. It finds that providers do not generally perceive Medicaid managed care as a catalyst for delivery system reform. Fragmented delivery systems, limits on the types of services for which managed care organizations are at risk, and the volatility in managed care markets all present challenges to improving care delivery. Policy and operational changes could enhance the role of Medicaid managed care in promoting patient-centered, coordinated, and high-quality care.