Delivery System Redesign

A medical home is an enhanced model of primary care that provides whole person, accessible, comprehensive, ongoing and coordinated patient-centered care. First advanced by the American Academy of Pediatrics in the 1960’s, the concept gained momentum in 2007 when four major physician groups agreed to a common view of the patient-centered medical home (PCMH) model defined by seven “Joint Principles.” NASHP’s medical home map allows you to click on a state to learn about its PCMH efforts.

In the United States, per capita spending on health care is more than double that in most other high-income, industrialized countries, including Australia, Germany, Japan, and Sweden. Yet performance on many health outcome measures in the U.S. lags these lower-spending nations. A New England Journal of Medicine Perspective examines two effective cost-containment strategies from abroad: Germany’s bundled payment system and Japan’s volume-driven pricing adjustment.

This Neiman Report highlights two of several emerging models being developed by the Harvey L. Neiman Health Policy Institute designed to align provision and payment of specialty care with efforts to ensure a sustainable, high quality health care system.

Bundled payment is the concept of paying a fixed dollar amount to cover a set of services, as an episode of care over a defined period. Because of the fixed price, providers are encouraged to hold variable costs down; yet BP programs usually require providers to satisfy a minimum set of quality metrics in order to receive payment, thus ensuring providers do not skimp on care. This paper examines issues confronted by two AF4Q communities that are considering or implementing BP initiatives.

States looking to implement accountable care organizations in Medicaid understand that payment reform alone is not sufficient to transform care delivery at the practice site level. Primary care providers, particularly those serving the health care safety net, require resources and guidance to meet the substantial quality and cost containment aspirations of the accountable care model. This brief outlines the types of technical assistance supports that state Medicaid agencies can potentially offer to help providers in transforming care delivery. It also provides key considerations for planning, implementing, and sustaining such technical assistance.