Delivery System Redesign

The federal government, commercial health plans, and other organizations are increasingly using measures of healthcare spending for the purposes of rewarding or penalizing physicians, hospitals, and other healthcare providers, defining provider networks, and encouraging patients to use particular providers. This report describes six fundamental problems with the current attribution and risk adjustment systems that are being used in these measures and explains how these problems could seriously harm both patients and healthcare providers. The report also describes how these problems can be solved using improved methodologies.

This report describes the efforts of 17 different states to transform their primary care delivery systems in order to improve the health of their populations and reduce costs. Since 2009, the Multi-state Collaborative has provided a forum for its members to collaborate across states and with the federal government, sharing data and lessons learned about investment in primary care transformation. The report highlights how these states went about transforming primary care to patient-centered medical homes (PCMH) through aligned payment reform.
 

Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target “high-need, high-cost” patients – those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. This study compares the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management.
 

Recognizing that health is determined by a variety of interrelated factors, states are looking to connect health care, public health, and social services to help achieve improved population health, better care, and reduced cost of care. This issue brief describes three essential components for integrating health, including physical and behavioral health, public health, and social services: 1) a coordinating mechanism, 2) quality measurement and data-sharing tools, and 3) aligned financing and payment. It also presents a five-step policy framework to help states move beyond isolated pilot efforts and establish the infrastructure necessary to support ongoing integration of health and social services.

Across the nation, public and private payers are combining forces to encourage providers in a given health care market to deliver more efficient, higher quality care. Payers can align on several fronts, including payment policies, quality measurement, administrative practices, and data-sharing. Drawing from the efforts of three state innovators (Maine, Vermont, and Wisconsin), this brief outlines promising strategies for quality measurement alignment across purchasers as a means to improving delivery system performance. The lessons can inform Medicaid and private purchasers in advancing a joint quality strategy.