Delivery System Redesign

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. 

The new National Scorecard on Payment Reform released today by Catalyst for Payment Reform is the first effort to measure progress in improving how health care is paid for in the United States. The Scorecard, produced with support from The Commonwealth Fund and the California HealthCare Foundation, finds that 11 percent of private health care payments to doctors and hospitals are tied to performance or designed to cut waste.

This report relays the experiences of seven accountable care organizations (ACOs) based on interviews with clinical and administrative leaders. The most advanced ACOs are seeing reductions or slower growth in health care costs and have anecdotal evidence of care improvements. Some of the ACOs studied have begun or are planning to share savings with providers if quality benchmarks are met.

In this report, the National Commission on Physician Payment Reform analyzes the factors contributing to the U.S.’s high health care spending, reviews how physicians are currently paid, and provides recommendations for reforming the physician payment system to drive higher quality and more cost-effective care.

This brief reports on the lessons and strategies of three states – Colorado, Minnesota, and Vermont – in their innovative health care payment and delivery system reforms. These states are pursuing different models for reform, but they have the same goal of aligning incentives between health care payers and providers to better coordinate care, enhance prevention and disease management, reduce avoidable utilization and total costs, and improve health outcomes.