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Fakeye OA, Khanna N, Hsu YJ, Marsteller JA. Impact of a Statewide Multi-Payer Patient-Centered Medical Home Program on Antihypertensive Medication Adherence. Popul Health Manag 2021; 25:309-316. [PMID: 34609933 DOI: 10.1089/pop.2021.0172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Evidence suggests that the patient-centered medical home (PCMH) model of primary care improves management of chronic disease, but there is limited research contrasting this model's effect when financed by a single payer versus multiple payers, and among patients with different types of health insurance. This study evaluates the impact of a statewide medical home demonstration, the Maryland Multi-Payer PCMH Program (MMPP), on adherence to antihypertensive medication therapy relative to non-PCMH primary care and to the PCMH model when financed by a single payer. The authors used a difference-in-differences analytic design to analyze changes in medication possession ratio for antihypertensive medications among Medicaid-insured and privately insured non-elderly adult patients attributed to primary care practices in the MMPP ("multi-payer PCMHs"), medical homes in Maryland that participated in a regional PCMH program funded by a single private payer ("single-payer PCMHs"), and non-PCMH practices in Maryland. Comparison sites were matched to multi-payer PCMHs using propensity scores based on practice characteristics, location, and aggregated provider characteristics. Multi-payer PCMHs performed better on antihypertensive medication adherence for both Medicaid-insured and privately insured patients relative to single-payer PCMHs. Statistically significant effects were not observed consistently until the second year of the demonstration. There were negligible differences in outcome trends between multi-payer medical homes and matched non-PCMH practices. Findings indicate that health care delivery innovations may yield superior population health outcomes under multi-payer financing compared to when such initiatives are financed by a single payer.
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Affiliation(s)
- Oludolapo A Fakeye
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Niharika Khanna
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill A Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Peikes D, Taylor EF, O'Malley AS, Rich EC. The Changing Landscape Of Primary Care: Effects Of The ACA And Other Efforts Over The Past Decade. Health Aff (Millwood) 2021; 39:421-428. [PMID: 32119624 DOI: 10.1377/hlthaff.2019.01430] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Providing high-quality primary care is key to improving health care in the United States. The Affordable Care Act sharpened the emerging focus on primary care as a critical lever to use in improving health care delivery, lowering costs, and improving the quality of care. We describe primary care delivery system reform models that were developed and tested over the past decade by the Center for Medicare and Medicaid Innovation-which was created by the Affordable Care Act-and reflect on key lessons and remaining challenges. Considerable progress has been made in understanding how to implement and support different approaches to improving primary care delivery in that decade, though evaluations showed little progress in spending or quality outcomes. This may be because none of the models was able to test substantial increases in primary care payment or strong incentives for other providers to coordinate with primary care to reduce costs and improve quality.
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Affiliation(s)
- Deborah Peikes
- Deborah Peikes ( dpeikes@mathematica-mpr. com ) is a senior fellow in the Health Policy Assessment division of Mathematica and is located in Princeton, New Jersey
| | - Erin Fries Taylor
- Erin Fries Taylor is a vice president and managing director of the Health Policy Assessment division of Mathematica and is located in Washington, D.C
| | - Ann S O'Malley
- Ann S. O'Malley is a senior fellow in the Health Policy Assessment division of Mathematica and is located in Washington, D.C
| | - Eugene C Rich
- Eugene C. Rich is a senior fellow in the Health Policy Assessment division of Mathematica and is located in Washington, D.C
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Yue X, Mu K, Liu L. Selection of Policy Instruments on Integrated Care in China: Based on Documents Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072327. [PMID: 32235602 PMCID: PMC7177394 DOI: 10.3390/ijerph17072327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 12/24/2022]
Abstract
Facing the aggravating trend of an aging population and a fragmented medical service delivery system, the Chinese Central Government has introduced a series of policies to promote the development of integrated care against the background of the “Healthy China Strategy”. The achievement of integrated care depends on the choice of policy instruments. However, few studies have focused on how policy instruments promote the practice of integrated care in China. This article aims to obtain a deeper understanding of the use of policy instruments in the development of integrated care in China. Policy documents are the carriers of policy instruments. National-level integrated care policy documents from 2009 to 2019 were selected. Using the qualitative document analysis method, this paper conducts an analysis of integrated care policy instruments. In order to comprehensively view the integrated care policy instruments, a three-dimensional analytical framework consisting of the policy instruments dimension, stakeholders dimension, and health service supply chains dimension is proposed. The results are as follows. (1) From the perspective of policy instruments, the integrated care policy has adopted supply-side policy instruments, demand-side policy instruments, and environmental policy instruments. Among the three types of policy instruments, environmental policy instruments are used most frequently, supply-side policies are preferred, while demand-side policy instruments are relatively inadequate. (2) As for the stakeholders dimension, the central policy instruments focus on the health service providers, while less attention is paid to the health service demanders. (3) In terms of health service supply chains, the number of policy instruments used in the prevention stage is the highest, followed by the treatment stage, whereas less attention paid to the rehabilitation stage. Finally, suggestions were made for the development of integrated care by better perfecting policy instruments.
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Affiliation(s)
- Xin Yue
- School of Public Administration, Central South University, Changsha 410083, China;
| | - Kaining Mu
- School of Nursing, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Lihang Liu
- School of Public Administration, Central South University, Changsha 410083, China;
- Correspondence:
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Pereira V, Gabriel MH, Unruh L. Multiyear Performance Trends Analysis of Primary Care Practices Demonstrating Patient-Centered Medical Home Transformation: An Observation of Quality Improvement Indicators among Outpatient Clinics. Am J Med Qual 2018; 34:109-118. [PMID: 30101596 DOI: 10.1177/1062860618792301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the ever-changing requirements of modern policy, payers seek interventions for care delivery improvement through value-based care models. Prior research acknowledges the Patient-Centered Medical Home (PCMH) as a tool for performance and outcomes improvement. However, these studies lack empirical evidence of performance trends across medical homes. A retrospective observational study was conducted to describe national trends in National Committee for Quality Assurance PCMH recognition for more than 23 000 primary care practices across the United States from 2008 to 2017. More than half of recognized practices scored 100% pass rates for activities related to appointment availability, patient care planning, and data for population management. The most common underperforming PCMH activities were for practice team, referral tracking and follow-up, and quality improvement implementation. Study findings indicate that patient-centered care collaboration between clinical and nonclinical team members, primary care provider coordination with specialty care providers, and practice implementation of clinical quality improvement methodologies are particularly challenging activities.
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Affiliation(s)
| | | | - Lynn Unruh
- 2 University of Central Florida, Orlando, FL
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5
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Fagnan LJ, Walunas TL, Parchman ML, Dickinson CL, Murphy KM, Howell R, Jackson KL, Madden MB, Ciesla JR, Mazurek KD, Kho AN, Solberg LI. Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment? Ann Fam Med 2018; 16:S72-S79. [PMID: 29632229 PMCID: PMC5891317 DOI: 10.1370/afm.2199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. METHODS The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. RESULTS A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. CONCLUSIONS Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more.
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Affiliation(s)
- Lyle J Fagnan
- Oregon Rural Practice-based Research Network (ORPRN), Portland, Oregon
| | - Theresa L Walunas
- Department of Medicine and Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael L Parchman
- Kaiser Permanente Washington Health Research Institute, MacColl Center for Health Care Innovation, Seattle, Washington
| | | | - Katrina M Murphy
- Oregon Rural Practice-based Research Network (ORPRN), Portland, Oregon
| | | | - Kathryn L Jackson
- Department of Medicine and Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Margaret B Madden
- Department of Medicine and Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James R Ciesla
- College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois
| | - Kathryn D Mazurek
- College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois
| | - Abel N Kho
- Department of Medicine and Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Marsteller JA, Hsu YJ, Gill C, Kiptanui Z, Fakeye OA, Engineer LD, Perlmutter D, Khanna N, Rattinger GB, Nichols D, Harris I. Maryland Multipayor Patient-centered Medical Home Program: A 4-Year Quasiexperimental Evaluation of Quality, Utilization, Patient Satisfaction, and Provider Perceptions. Med Care 2018; 56:308-320. [PMID: 29462077 PMCID: PMC5882272 DOI: 10.1097/mlr.0000000000000881] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries' experiences and satisfaction with care; and (3) perceptions of providers. DESIGN 4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries. SUBJECTS Beneficiaries (Medicaid-insured and privately insured) and providers in 52 MMPP practices and 104 matched comparisons in Maryland. INTERVENTION Participating practices received unconditional financial support and coaching to facilitate functioning as medical homes, membership in a learning collaborative to promote education and dissemination of best practices, and performance-based payments. MEASURES Sixteen quality, 20 utilization, and 13 cost measures from administrative data; patient-reported outcomes on care delivery, trust in provider, access to care, and chronic illness management; and provider perceptions of team operation, team culture, satisfaction with care provided, and patient-centered medical home transformation. RESULTS The MMPP had mixed impact on site-level quality and utilization measures. Participation was significantly associated with lower inpatient and outpatient payments in the first year among privately insured beneficiaries, and for the entire duration among Medicaid beneficiaries. There was indication that MMPP practices shifted responsibility for certain administrative tasks from clinicians to medical assistants or care managers. The program had limited effect on measures of patient satisfaction (although response rates were low) and on provider perceptions. CONCLUSIONS The MMPP demonstrated mixed results of its impact and indicated differential program effects for privately insured and Medicaid beneficiaries.
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Affiliation(s)
- Jill A. Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | | | - Oludolapo A. Fakeye
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Lilly D. Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | - Niharika Khanna
- Department of Family and Community Medicine (NK), University of Maryland School of Medicine, Baltimore, MD
| | - Gail B. Rattinger
- Department of Health Outcomes and Administrative Sciences (GBR), Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY
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Peiris D, Phipps-Taylor MC, Stachowski CA, Kao LS, Shortell SM, Lewis VA, Rosenthal MB, Colla CH. ACOs Holding Commercial Contracts Are Larger And More Efficient Than Noncommercial ACOs. Health Aff (Millwood) 2018; 35:1849-1856. [PMID: 27702959 DOI: 10.1377/hlthaff.2016.0387] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Accountable care organizations (ACOs) have diverse contracting arrangements and have displayed wide variation in their performance. Using data from national surveys of 399 ACOs, we examined differences between the 228 commercial ACOs (those with commercial payer contracts) and the 171 noncommercial ACOs (those with only public contracts, such as with Medicare or Medicaid). Commercial ACOs were significantly larger and more integrated with hospitals, and had lower benchmark expenditures and higher quality scores, compared to noncommercial ACOs. Among all of the ACOs, there was low uptake of quality and efficiency activities. However, commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods than did noncommercial ACOs. Few ACOs reported having high-level performance monitoring capabilities. About two-thirds of the ACOs had established processes for distributing any savings accrued, and these ACOs allocated approximately the same amount of savings to the ACOs themselves, participating member organizations, and physicians. Our findings demonstrate that ACO delivery systems remain at a nascent stage. Structural differences between commercial and noncommercial ACOs are important factors to consider as public policy efforts continue to evolve.
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Affiliation(s)
- David Peiris
- David Peiris is a Harkness Fellow at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Madeleine C Phipps-Taylor
- Madeleine C. Phipps-Taylor is a director of Allocate Software Ltd., in London, United Kingdom. At the time of this study, she was a 2014-15 Harkness Fellow at the School of Public Health at the University of California, Berkeley
| | - Courtney A Stachowski
- Courtney A. Stachowski is a research project specialist at the Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, New Hampshire
| | - Lee-Sien Kao
- Lee-Sien Kao is an associate at ideas42, in Washington, D.C. At the time of this study, she was a health policy fellow at the Dartmouth Institute for Health Policy and Clinical Practice
| | - Stephen M Shortell
- Stephen M. Shortell is the Blue Cross of California Distinguished Professor of Health Policy and Management, a professor of organization behavior, director of the Center for Healthcare Organizational and Innovation Research, and dean emeritus, all at the School of Public Health, University of California, Berkeley
| | - Valerie A Lewis
- Valerie A. Lewis is an assistant professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice
| | - Meredith B Rosenthal
- Meredith B. Rosenthal is a professor of health economics and policy in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health
| | - Carrie H Colla
- Carrie H. Colla is an associate professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice
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8
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Sarinopoulos I, Bechel-Marriott DL, Malouin JM, Zhai S, Forney JC, Tanner CL. Patient Experience with the Patient-Centered Medical Home in Michigan's Statewide Multi-Payer Demonstration: A Cross-Sectional Study. J Gen Intern Med 2017; 32:1202-1209. [PMID: 28808852 PMCID: PMC5653555 DOI: 10.1007/s11606-017-4139-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 04/11/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The literature on patient-centered medical homes (PCMHs) and patient experience is somewhat mixed. Government and private payers are promoting multi-payer PCMH initiatives to align requirements and resources and to enhance practice transformation outcomes. To this end, the multipayer Michigan Primary Care Transformation (MiPCT) demonstration project was carried out. OBJECTIVE To examine whether the PCMH is associated with a better patient experience, and whether a mature, multi-payer PCMH demonstration is associated with even further improvement in the patient experience. DESIGN This is a cross-sectional comparison of adults attributed to MiPCT PCMH, non-participating PCMH, and non-PCMH practices, statistically controlling for potential confounders, and conducted among both general and high-risk patient samples. PARTICIPANTS Responses came from 3893 patients in the general population and 4605 in the high-risk population (response rates of 31.8% and 34.1%, respectively). MAIN MEASURES The Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey, with PCMH supplemental questions, was administered in January and February 2015. KEY RESULTS MiPCT general and high-risk patients reported a significantly better experience than non-PCMH patients in most domains. Adjusted mean differences were as follows: access (0.35**, 0.36***), communication (0.19*, 0.18*), and coordination (0.33**, 0.35***), respectively (on a 10-point scale, with significance indicated by: *= p<0.05, **= p<0.01, and ***= p<0.001). Adjusted mean differences in overall provider ratings were not significant. Global odds ratios were significant for the domains of self-management support (1.38**, 1.41***) and comprehensiveness (1.67***, 1.61***). Non-participating PCMH ratings fell between MiPCT and non-PCMH across all domains and populations, sometimes attaining statistical significance. CONCLUSIONS PCMH practices have more positive patient experiences across domains characteristic of advanced primary care. A mature multi-payer model has the strongest, most consistent association with a better patient experience, pointing to the need to provide consistent expectations, resources, and time for practice transformation. Our results held for a general population and a high-risk population which has much more contact with the healthcare system.
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Affiliation(s)
| | | | - Jean M Malouin
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Shaohui Zhai
- Michigan Public Health Institute, Okemos, MI, USA
| | | | - Clare L Tanner
- Michigan Public Health Institute, Okemos, MI, USA. .,Center for Data Management and Translational Research, Michigan Public Health Institute, 2501 Jolly Road, Suite 180, Okemos, MI, USA.
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Anglin G, Tu HA, Liao K, Sessums L, Taylor EF. Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative. Milbank Q 2017; 95:602-633. [PMID: 28895218 DOI: 10.1111/1468-0009.12280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations. CONTEXT With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation. However, sustaining engagement and achieving coordination among payers can be challenging. The Comprehensive Primary Care (CPC) initiative is one of the largest multipayer initiatives ever tested. Drawing on the experience of the CPC initiative, this paper examines the factors that influence the effectiveness of multipayer collaboration. METHODS This paper draws largely on semistructured interviews with CPC-participating payers and payer conveners that facilitated CPC discussions and on observation of payer meetings. We coded and analyzed these qualitative data to describe collaborative dynamics and outcomes and assess the factors influencing them. FINDINGS We found that several factors appeared to increase the likelihood of successful payer collaboration: contracting with effective, neutral payer conveners; leveraging the support of payer champions, and seeking input on decisions from practice representatives. The presence of these factors helped some CPC regions overcome significant initial barriers to achieve common goals. We also found that leadership from the Centers for Medicare & Medicaid Services (CMS) was key to achieving broad payer engagement in CPC, but CMS's dual role as initiative convener and participating payer at times made collaboration challenging. CMS was able to build trust with other payers by clarifying which parts of CPC could be adapted to regional contexts, deferring to other payers for these decisions, and increasing opportunities for payers to meet with CMS representatives. CONCLUSIONS CPC demonstrates that when certain facilitating factors are present, payers can overcome competitive market dynamics and competing institutional priorities to align financial incentives, quality measurement, and data feedback to support practice transformation. Lessons from this large-scale, multipayer initiative may be helpful for other multipayer efforts getting under way.
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Affiliation(s)
| | - H A Tu
- Mathematica Policy Research, Inc
| | - Kristie Liao
- John F. Kennedy School of Government, Harvard University
| | - Laura Sessums
- Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
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Ahluwalia SC, Damberg CL, Silverman M, Motala A, Shekelle PG. What Defines a High-Performing Health Care Delivery System: A Systematic Review. Jt Comm J Qual Patient Saf 2017; 43:450-459. [PMID: 28844231 PMCID: PMC8493928 DOI: 10.1016/j.jcjq.2017.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/28/2017] [Accepted: 03/15/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Purchasers, payers, and policy makers are increasingly measuring and rewarding high-performing health systems, which use a variety of definitions of high performance, yet it is unclear if a consistently applied definition exists. A systematic review was conducted to determine if there is a commonly used, agreed-on definition of what constitutes a "high-performing" health care delivery system. METHODS Searches were conducted for English-language articles defining high performance with respect to a health care system or organization in PubMed and WorldCat databases from 2005 to 2015 and the New York Academy of Medicine Grey Literature Report from 1999 to 2016. The entity/condition to which the definition was applied was extracted from included articles. The number and type of dimensions used to define high performance within and across articles was tabulated and the number and type of metrics used by performance dimension and by article was calculated. RESULTS No consistent definition of a high-performing health care system or organization was identified. High performance was variably defined across different dimensions, including quality (93% of articles), cost (67%), access (35%), equity (26%), patient experience (21%), and patient safety (18%). Most articles used more than one dimension to define high performance (75%), but only five used five or more dimensions. The most commonly paired dimensions were quality and cost (63%). CONCLUSION The absence of a consistent definition of what constitutes high performance and how to measure it hinders our ability to compare and reward health care delivery systems on performance, underscoring the need to develop a consistent definition of high performance.
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11
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Physician Payment Methods and the Patient-Centered Medical Home. J Ambul Care Manage 2017; 40:114-120. [DOI: 10.1097/jac.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takach M. Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience. Popul Health Manag 2015; 19:357-67. [PMID: 26636485 PMCID: PMC5036321 DOI: 10.1089/pop.2015.0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes-all core attributes of a medical home. This qualitative study looked at 4 different PHCO models-3 from the United States and 1 from Australia-with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system.
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Affiliation(s)
- Mary Takach
- 1 National Academy for State Health Policy , Portland, Maine
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13
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Jones C, Finison K, McGraves-Lloyd K, Tremblay T, Mohlman MK, Tanzman B, Hazard M, Maier S, Samuelson J. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care. Popul Health Manag 2015; 19:196-205. [PMID: 26348492 PMCID: PMC4913508 DOI: 10.1089/pop.2015.0055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by −$482 relative to the comparison (95% CI, −$573 to −$391; P < .001). The lower costs were driven primarily by inpatient (−$218; P < .001) and outpatient hospital expenditures (−$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196–205)
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Affiliation(s)
- Craig Jones
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | | | | | - Timothy Tremblay
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Mary Kate Mohlman
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Beth Tanzman
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Miki Hazard
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Steven Maier
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
| | - Jenney Samuelson
- 1 Vermont Blueprint for Health , Department of Health Access, Williston, Vermont
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Cunningham R. Once A Welfare Add-On, Medicaid Takes Charge In Reinventing Care. Health Aff (Millwood) 2015; 34:1080-3. [DOI: 10.1377/hlthaff.2015.0552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rob Cunningham
- Rob Cunningham ( ) is a consulting editor for Health Affairs . He is based in Gaithersburg, Maryland
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