Delivery System Redesign

This brief examines several case studies from the AF4Q communities and the care-across-settings initiatives that they are undertaking. Their experiences demonstrate that the weakest link in a patient’s care is often the transition from one setting to another, but our health care system does not have consistent systems or funds in place for establishing care transitions programs.

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.

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.

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. 

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.

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.

There are several different approaches to promoting patient-centered care: creating medical homes, helping patients to become partners in treatment decisions, and instituting payment reforms that enable doctors to be reimbursed for time spent counseling patients about healthy behaviors, for e-mail consultations, and for coordinating care with other providers. Little is known, however, about how health care organizations choose their approach and set goals. In this Commonwealth Fund–supported study, researchers interviewed health plan leaders and providers in Washington State, a leader in patient-centered innovation.

This report analyzes the early experiences of the State Action on Avoidable Rehospitalizations (STAAR) initiative, which is a program implemented in Massachusetts, Michigan, and Washington focused on reducing preventable hospital readmissions. Three key barriers to success were identified: 1) forming productive, collaborative relationships across care settings; 2) identifying effective interventions, especially across settings; and 3) addressing a lack of quality improvement capabilities among some health care providers. 

This brief examines the provisions in the ACA oriented towards transforming the American health care delivery system from a system that rewards volume to a system that rewards quality and value. These provisions hold the potential to reduce the rate of cost growth and improve the quality of care delivery through more coordinated care delivery models and reimbursement methods that reward coordinated care.

The Centers for Medicare and Medicaid Services (CMS) has finalized memoranda of understanding (MOUs) with Massachusetts and Ohio to test a capitated financial alignment model to integrate care and align financing for people who are dually eligible for Medicare and Medicaid in 2013. This fact sheet compares the key components of the Massachusetts and Ohio demonstrations.