Delivery System Redesign

States and the federal government are investing heavily in state demonstrations to reform the health care delivery system, and gauging the impact of these demonstrations through monitoring and evaluation requires time and effort from both state and federal officials. Greater alignment between state and federal evaluation and monitoring activities and across programs could streamline reporting requirements, ease administrative burden, and improve the effectiveness and efficiency of monitoring and evaluation. In June 2015, the National Academy for State Health Policy convened state and federal leaders to identify actionable steps toward a shared federal and state agenda on improving the monitoring and evaluation of state demonstrations. This brief reflects on the convening’s discussion.

As the U.S. population ages, the need for long-term services and supports (LTSS) is increasing, and policy makers are grappling with how to finance this huge expense. The ACA included a plan to enhance the private market with a national voluntary long-term care insurance program, but Congress repealed it before it launched. Now, there is a flurry of activity as groups develop new financing approaches. This new Alliance for Health Reform toolkit explains the current LTSS system, trends in the delivery of care, and the current policy challenges.

This brief discusses the fact that payment reform focusing on value and quality is driving change that is redefining the hospital’s role in the continuum of care and the health of the broader population. This brief also identifies opportunities for state policymakers to encourage the evolution of hospital community benefit policy in ways that complement and support the realignment of the hospital business model, proactively address the social determinants of health, and ultimately improve the health of the entire community.

The rise in complex chronic conditions is contributing to increasing health care costs, poorer quality of life, and greater health inequities. While seen as preventable, tackling these conditions will require multisectoral, systems-level solutions. On July 23 at 1:00 p.m. EDT, this free webinar will detail a unique and longstanding multisectoral partnership to address asthma and poor housing conditions in Boston. This webinar will describe program, policy and systems change strategies that have improved multifamily housing and ensured that residents with asthma have access to healthier home environments.

One of the barriers to reaching consensus on significant payment reforms has been the complex and confusing array of terminology that has been used to describe different payment systems. It is difficult for stakeholders to determine whether to support a proposal if they do not understand the words and abbreviations used to describe it, and it is difficult to reach agreement when the same words are used by different people to mean different things or when words are perceived by some stakeholders to mean something different than what was actually intended. This Payment Reform Glossary is designed to facilitate a better understanding of payment reform concepts and to create a foundation for a common language for developing and discussing payment reform concepts so they can be supported and implemented by all stakeholders — patients, providers, employers, health plans, and government agencies.

Social determinants of health have taken center stage in recent discussions of health policy in the wake of the ACA. Health care providers are being asked to extend the models' impact beyond costs and quality of health care into what has traditionally been beyond the providers' sphere of influence: the health outcomes of the population they serve. Although health policy makers have traditionally considered nonmedical influences on health to be the domain of other state agencies and nonprofit actors, a reconsideration of how the social determinants of health can be addressed within the current health policy landscape is underway. This report summarizes and synthesizes existing evidence about the impact of investing in social services and partnerships between health care and social services, paying special attention to the innovative models for improving health outcomes and reducing health care costs.

Delivery system and payment reform are dynamic and ever-evolving policy areas of state Medicaid programs; virtually every state has initiatives underway. This interactive map is designed to provide users with an environmental scan of the activity, to help introduce these complex concepts and also dive deeper. It allows users to explore specific initiatives more in depth, and it also provides related briefs that elucidate these concepts.

The medical home model of health care delivery has been widely embraced over the past decade. Medical home interventions encourage primary care practices to adopt this model, which aims to provide accessible, well-coordinated, patient-centered care and incorporates elements like disease management, patient registries, and electronic health records. This study evaluating the impact of medical home interventions on quality of care found that a group of physician practices participating in a medical home intervention that included a shared-savings bonus program outperformed a comparison group of practices on clinical quality. Patients in the participating practices also had comparatively fewer hospital and emergency room visits.

In the five years since the ACA was passed, the nation's attention has shifted from the law's insurance market reforms and the bumpy rollout of healthcare.gov to the success of the marketplaces in covering millions of previously uninsured Americans. Far less attention has been paid to the parts of "Obamacare" that target problems with how health care is delivered and paid for, many of which become apparent when people receive their insurance card and seek out care.

While many health care organizations are motivated to identify and reduce racial and ethnic disparities in the health and health care of their patients, most lack the tools and resources to do so effectively. To identify ways to address disparities more effectively, Aligning Forces for Quality, an initiative of the Robert Wood Johnson Foundation, partnered with Finding Answers: Disparities Research for Change and the Center for Health Care Strategies to work with nine outpatient practices and their communities. This paper shares the lessons learned from these nine organizations in implementing innovative programming to address disparities in their patient populations. It includes concrete recommendations that other health care organizations can use to improve the quality of their health care delivery systems and implement interventions to address inequities in patient care and outcomes.