Doug McCarthy

The Commonwealth Fund’s newly updated evidence guide and a companion return-on-investment calculator can help health care organizations plan their investments in social need interventions.

Introduction: To improve services and assure predictable costs of care for Children and Youth with Special Health Care Needs (CYSHCN), state Title V and Medicaid programs are cooperating to reconceive care systems including contracting arrangements with managed care organizations (MCOs). This article describes how a consensus-based framework, the National Standards for Systems of Care for CYSHCN, influenced the redesign of two state Medicaid managed care programs: a statewide managed care plan… Show more

Introduction: To improve services and assure predictable costs of care for Children and Youth with Special Health Care Needs (CYSHCN), state Title V and Medicaid programs are cooperating to reconceive care systems including contracting arrangements with managed care organizations (MCOs). This article describes how a consensus-based framework, the National Standards for Systems of Care for CYSHCN, influenced the redesign of two state Medicaid managed care programs: a statewide managed care plan for children with medical complexity in Florida and a regional accountable care program serving children and adults in Colorado.
Methods: Data are drawn from a recent evaluation of the National Standards, which define the core components of a comprehensive, coordinated, and family-centered system of care for CYSHCN. The authors synthesized insights from documents and semi-structured interviews with national and state stakeholders.
Results: The states used the National Standards in different ways. Florida translated the Standards into contract provisions and holds its MCO accountable to performance targets specific to CYSHCN. In Colorado, the Standards had an indirect influence on contract provisions with regional accountable entities (RAEs) and the state’s oversight of EPSDT, which helps ensure that RAEs meet their obligations to CYSHCN. Managed care leaders viewed the Standards as an impetus to sharpen quality improvement and foster whole-person care.
Discussion: The National Standards offer a flexible framework to help states design Medicaid managed care programs and improve systems of care for CYSHCN. States can learn from one another’s experiences applying the Standards in the context of their policy environments. Show less

With funding from the Missouri Foundation for Health, the project synthesized insights from more than 270 Missouri constituents to develop a framework for stakeholder engagement, use cases, governance, funding, and technical considerations for building a statewide health information infrastructure to improve health and health care for Missourians. The Blueprint may be of interest to other states as well.

The National Health Foundation provides comprehensive recuperative care to people experiencing homelessness, helping improve their health outcomes and reduce hospital readmissions.

By aggregating data on patient services that insurers and public programs pay for, all-payer claims databases can aid states’ efforts to control rising costs and increase the value of health care.

Integrating health and social services is increasingly important, particularly now as patients with complex needs cope with the COVID-19 pandemic. Homage — a nonprofit organization serving Snohomish County, Washington — saw an opportunity to help improve the health of its clients when a change in federal policy granted Medicare Advantage (MA) plans greater flexibility to include some nonmedical services as supplemental benefits. They approached an MA plan to explore the possibility of a… Show more

Integrating health and social services is increasingly important, particularly now as patients with complex needs cope with the COVID-19 pandemic. Homage — a nonprofit organization serving Snohomish County, Washington — saw an opportunity to help improve the health of its clients when a change in federal policy granted Medicare Advantage (MA) plans greater flexibility to include some nonmedical services as supplemental benefits. They approached an MA plan to explore the possibility of a partnership to provide care coordination and social services as a cost-saving intervention for the plan’s high-need, high-cost members, but needed to make the business case for providing these services.

This blog post describes Homage’s efforts to determine the return on investment (ROI) of the nonprofit’s services and its experience using an online ROI Calculator developed by The Commonwealth Fund. The ROI Calculator is designed to assist community-based organizations (CBOs) and their health care partners in creating financial arrangements to fund social services. The blog post shares practical resources for other organizations interested in using the tool.
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The Massachusetts Health Policy Commission (HPC) promotes health care cost containment by setting a statewide spending growth target and monitoring payer and provider performance against it; investigating and reporting on drivers of the total cost of care; reviewing the cost and market impact of provider combinations; providing technical support and grants to foster care delivery transformation; and making data-driven policy recommendations for health care reforms. The average rate of growth in… Show more

The Massachusetts Health Policy Commission (HPC) promotes health care cost containment by setting a statewide spending growth target and monitoring payer and provider performance against it; investigating and reporting on drivers of the total cost of care; reviewing the cost and market impact of provider combinations; providing technical support and grants to foster care delivery transformation; and making data-driven policy recommendations for health care reforms. The average rate of growth in total health care spending per capita in Massachusetts has been below the HPC’s benchmark from 2013 to 2018. Show less

ISSUE: Setbacks and outright failures are inherent to innovation and provide an opportunity for health care leaders to learn as they design new care models that improve health outcomes while reducing costs and unnecessary service use. Unfortunately, many organizations have not developed the discipline for learning from such challenges.
GOAL: To share methods innovators used to develop new care models and overcome obstacles during their implementation, as well as lessons from their… Show more

ISSUE: Setbacks and outright failures are inherent to innovation and provide an opportunity for health care leaders to learn as they design new care models that improve health outcomes while reducing costs and unnecessary service use. Unfortunately, many organizations have not developed the discipline for learning from such challenges.
GOAL: To share methods innovators used to develop new care models and overcome obstacles during their implementation, as well as lessons from their failures.
METHODS: Interviews with care model innovators.
FINDINGS AND CONCLUSION: When designing new care models, leaders should strive to understand which patients fail to benefit and consider changing staff to better meet patients’ needs. They should seek to identify which elements of their models are most essential and find common ground with health care payers on how to measure and reward success. Show less

Advanced illness management programs help patients manage their disease, clarify end-of life goals, and work through delicate issues. Along with improving patients’ quality of life, advanced illness management programs have demonstrated cost savings by helping patients avoid complications and unnecessary care.

The Commonwealth Fund’s Scorecard on State Health System Performance assesses all 50 states and the District of Columbia on more than 40 measures of access to health care, quality of care, efficiency in care delivery, health outcomes, and income-based health care disparities. Overall, four major trends emerge from our analysis of the Scorecard results:
1. Rising death rates, high levels of obesity, and gaps in care are pressing challenges for states
2. Regional differences in performance… Show more

The Commonwealth Fund’s Scorecard on State Health System Performance assesses all 50 states and the District of Columbia on more than 40 measures of access to health care, quality of care, efficiency in care delivery, health outcomes, and income-based health care disparities. Overall, four major trends emerge from our analysis of the Scorecard results:
1. Rising death rates, high levels of obesity, and gaps in care are pressing challenges for states
2. Regional differences in performance persist, as do within-state disparities
3. Many states are not getting good value for their health care dollars
4. States made progress in areas that were the target of efforts to improve. Show less

Change is hard — whether for individuals trying to adopt healthy lifestyles or for communities seeking to improve their residents’ health. So perhaps it’s not surprising that only 14 of 306 local health care markets made substantial progress over three years on a majority of the indicators tracked by the Commonwealth Fund’s most recent Scorecard on Local Health System Performance.

What’s encouraging is that more than half of the 14 most-improved communities had higher rates of poverty… Show more

Change is hard — whether for individuals trying to adopt healthy lifestyles or for communities seeking to improve their residents’ health. So perhaps it’s not surprising that only 14 of 306 local health care markets made substantial progress over three years on a majority of the indicators tracked by the Commonwealth Fund’s most recent Scorecard on Local Health System Performance.

What’s encouraging is that more than half of the 14 most-improved communities had higher rates of poverty than the nation as a whole. Some started from a lower position in the previous rankings and thus had greater opportunity to improve. Yet, their gains can be seen as a hopeful sign that even communities with limited resources can make progress.

To understand how these communities made health care better for their residents, we zoomed in on three — Paducah, Kentucky; Pueblo, Colorado; and Stockton, California — as well as a fourth community at the top of the most-improved list: Akron, Ohio, where the poverty rate is closer to the national average.

Here's what we found:
1. Local governments acted as catalysts for change.
2. Health care organizations cooperated to achieve shared goals.
3. Data often guided action.

Read in-depth reports of change in these communities to learn more. Show less

ISSUE: Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending.
GOAL: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with… Show more

ISSUE: Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending.
GOAL: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey.
FINDINGS: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured high-need adults reported the greatest difficulties having their needs met.
CONCLUSION: The health care system needs to work better for the highest-need, most-complex patients. This study’s findings highlight the importance of tailoring interventions to address their needs. Show less

ISSUE: Finding ways to improve outcomes and reduce spending for patients with complex and costly care needs requires an understanding of their unique needs and characteristics.
GOAL: Examine demographics and health care spending and use of services among adults with high needs, defined as people who have three or more chronic diseases and a functional limitation in their ability to care for themselves or perform routine daily tasks.
METHODS: Analysis of data from the 2009–2011 Medical… Show more

ISSUE: Finding ways to improve outcomes and reduce spending for patients with complex and costly care needs requires an understanding of their unique needs and characteristics.
GOAL: Examine demographics and health care spending and use of services among adults with high needs, defined as people who have three or more chronic diseases and a functional limitation in their ability to care for themselves or perform routine daily tasks.
METHODS: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey.
FINDINGS: High-need adults differed notably from adults with multiple chronic diseases but no functional limitations. They had annual health care expenditures that were nearly three times higher—and which were more likely to remain high over two years of observation—and out-of-pocket expenses that were more than a third higher, despite their lower incomes. On average, rates of hospital use for high-need adults were more than twice those for adults with multiple chronic conditions only; high-need adults also visited the doctor more frequently and used more home health care.
CONCLUSION: Wide variation in costs and use of services within the high-need group suggests that interventions should be targeted and tailored to those individuals most likely to benefit. Show less

The 2016 edition of The Commonwealth Fund’s Scorecard on Local Health System Performance finds continuing wide variation in health and health care across U.S. communities. In its assessment of 36 indicators of access, quality, avoidable hospital use, costs, and outcomes, we see that health care improved more than it worsened between 2011 and 2014 in nearly all 306 local areas. Gains in access to care, quality, and efficiency often corresponded to implementation of public policies, such as the… Show more

The 2016 edition of The Commonwealth Fund’s Scorecard on Local Health System Performance finds continuing wide variation in health and health care across U.S. communities. In its assessment of 36 indicators of access, quality, avoidable hospital use, costs, and outcomes, we see that health care improved more than it worsened between 2011 and 2014 in nearly all 306 local areas. Gains in access to care, quality, and efficiency often corresponded to implementation of public policies, such as the Affordable Care Act, and to quality improvement collaborations. But lack of progress on many indicators suggests further efforts are needed. Notably, mortality rates were mostly unchanged, and obesity rates rose in 111 of 306 localities. Health system performance is often linked to resource availability, with areas that have a high proportion of low-income residents tending to rank lower. Exceptions to this suggest, however, that local improvement efforts can succeed despite socioeconomic challenges. Show less

This brief analyzes experts’ reviews of evidence about care models designed to improve outcomes and reduce costs for patients with complex needs. It finds that successful models have several common attributes: targeting patients likely to benefit from the intervention; comprehensively assessing patients’ risks and needs; relying on evidence-based care planning and patient monitoring; promoting patient and family engagement in self-care; coordinating care and communication among patients and… Show more

This brief analyzes experts’ reviews of evidence about care models designed to improve outcomes and reduce costs for patients with complex needs. It finds that successful models have several common attributes: targeting patients likely to benefit from the intervention; comprehensively assessing patients’ risks and needs; relying on evidence-based care planning and patient monitoring; promoting patient and family engagement in self-care; coordinating care and communication among patients and providers; facilitating transitions from the hospital and referrals to community resources; and providing appropriate care in accordance with patients’ preferences. Overall, the evidence of impact is modest and few of these models have been widely adopted in practice because of barriers, such as a lack of supportive financial incentives under fee-for-service reimbursement arrangements. Overcoming these challenges will be essential to achieving a higher-performing health care system for this patient population. Show less

As value-based payment in health care increasingly takes hold, many provider organizations are seeking to promote better health not just for individual patients but for entire populations. Such population-based health activities require collaboration among acute, postacute, and community care providers. Drawing on examples of communities across the nation that are engaged in efforts to reduce hospital readmissions, the authors suggest that effective collaboration requires: a trusted convener… Show more

As value-based payment in health care increasingly takes hold, many provider organizations are seeking to promote better health not just for individual patients but for entire populations. Such population-based health activities require collaboration among acute, postacute, and community care providers. Drawing on examples of communities across the nation that are engaged in efforts to reduce hospital readmissions, the authors suggest that effective collaboration requires: a trusted convener, whether an individual or an organization; the cultivation of trust, through a focus on the benefits of the partnership and common goals; a shared understanding of the challenges faced by each participant, achieved through site visits and shadowing activities; starting small and building on early progress; expanding the type and number of participants as needs arise; using both quantitative and qualitative data to identify opportunities for improvement and monitoring progress; and focusing on patients’ needs and experiences to help spur action. Show less

Health care innovation centers around the country are working to discover, develop, test, and spread new models of care delivery—in hospitals, clinics, and patients’ homes. Between November 2014 and January 2015, The Commonwealth Fund conducted an online survey of innovation centers affiliated with health care organizations to learn about their potential role in promoting health system transformation.

Survey findings presented in this chartpack reveal how innovation centers define… Show more

Health care innovation centers around the country are working to discover, develop, test, and spread new models of care delivery—in hospitals, clinics, and patients’ homes. Between November 2014 and January 2015, The Commonwealth Fund conducted an online survey of innovation centers affiliated with health care organizations to learn about their potential role in promoting health system transformation.

Survey findings presented in this chartpack reveal how innovation centers define innovation, what factors into investment decisions, which technologies are most commonly used, and much more. While innovation centers have the potential to contribute to health system transformation, it appears that to succeed they will need sustainable funding and greater integration with clinical enterprises. The survey also reveals that innovation centers may benefit from collaboration to identify solutions to common problems and develop a mechanism for spreading their work. Show less

This case study series describes how three diverse organizations—Health Share of Oregon, Hill Physicians Medical Group, and Marshfield Clinic—are developing accountable care systems to improve the quality and reduce the costs of care, and ultimately improve the health of populations of patients insured by Medicare, Medicaid, and commercial health plans. They employ a constellation of strategies to identify and address unmet medical needs, improve care transitions, and reduce inefficiencies and… Show more

This case study series describes how three diverse organizations—Health Share of Oregon, Hill Physicians Medical Group, and Marshfield Clinic—are developing accountable care systems to improve the quality and reduce the costs of care, and ultimately improve the health of populations of patients insured by Medicare, Medicaid, and commercial health plans. They employ a constellation of strategies to identify and address unmet medical needs, improve care transitions, and reduce inefficiencies and unnecessary variation in care. Care managers, outreach workers, or virtual care teams help improve outcomes for patients with complex needs that are costly to treat. Data integration and analytics are key to their efforts, although the sophistication of these capabilities varies. Two study sites have established a record of savings, while the third is still proving the potential of its approach. Their progress to date suggests that payment reforms can foster the will and accountability necessary to transform care. Show less

Unlike other sectors of the economy, the health care industry has yet to realize the potential of digital technologies. These tools, which allow for the rapid exchange of text, images, and data, have transformed the retail and travel industries by allowing companies to discover customers’ unique needs and preferences and leverage that information to deliver products and services in new and more convenient ways. The health care industry now has the opportunity to catch up, using tools ranging… Show more

Unlike other sectors of the economy, the health care industry has yet to realize the potential of digital technologies. These tools, which allow for the rapid exchange of text, images, and data, have transformed the retail and travel industries by allowing companies to discover customers’ unique needs and preferences and leverage that information to deliver products and services in new and more convenient ways. The health care industry now has the opportunity to catch up, using tools ranging from smartphones and tablet computers to remote sensors and monitoring devices to deliver care, information, and support to patients where and when they need it. These technologies also can play a key role in closing communication gaps between providers and patients and in forging new relationships among providers and their peers. Show less

Digital health technologies—ranging from wearable sensors and portable diagnostic technologies to telemedicine tools and mobile health care apps—have the potential to transform the health care delivery system by empowering consumers to play an active role in their care and define what services are important to them. They also can help health care providers, insurers, and others analyze a growing body of data to identify unmet needs and measure treatment outcomes to better tailor patient… Show more

Digital health technologies—ranging from wearable sensors and portable diagnostic technologies to telemedicine tools and mobile health care apps—have the potential to transform the health care delivery system by empowering consumers to play an active role in their care and define what services are important to them. They also can help health care providers, insurers, and others analyze a growing body of data to identify unmet needs and measure treatment outcomes to better tailor patient interventions. Still, there are significant barriers to the development and adoption of effective digital health technologies. This report outlines these challenges and makes recommendations for overcoming them, with the explicit goal of encouraging clinicians, developers, and entrepreneurs to focus on the needs of patients with complex and costly medical and behavioral health conditions. Our recommendations are informed by interviews with clinicians, entrepreneurs, investors, and consumer advocates as well as our own research, and are founded on the premise that such technologies will work toward achieving the vision of the triple aim: improving population health, improving care experiences, and reducing per capita costs of care. Show less

As health care providers adopt and make “meaningful use” of health information technology (health IT), communities and delivery systems must set up the infrastructure to facilitate health information exchange (HIE) between providers and numerous other stakeholders who have a role in supporting health and care. By facilitating better communication and coordination between providers, HIE has the potential to improve clinical decision-making and continuity of care, while reducing unnecessary use… Show more

As health care providers adopt and make “meaningful use” of health information technology (health IT), communities and delivery systems must set up the infrastructure to facilitate health information exchange (HIE) between providers and numerous other stakeholders who have a role in supporting health and care. By facilitating better communication and coordination between providers, HIE has the potential to improve clinical decision-making and continuity of care, while reducing unnecessary use of services. When implemented as part of a broader strategy for health care delivery system and payment reform, HIE capability also can enable the use of analytic tools needed for population health management, patient engagement in care, and continuous learning and improvement. The diverse experiences of seven communities that participated in the three-year federal Beacon Community Program offer practical insight into factors influencing the technical architecture of exchange infrastructure and its role in supporting improved care, reduced cost, and a healthier population. The case studies also document challenges faced by the communities, such as significant time and resources required to harmonize variations in the interpretation of data standards. Findings indicate that their progress developing community-based HIE strategies, while driven by local needs and objectives, is also influenced by broader legal, policy, and market conditions. Show less

In the United States, where a person lives determines the kind of health care available and the length and quality of life a person is likely to enjoy. The 2014 edition of The Commonwealth Fund’s Scorecard on State Health System Performance1 documents persistently wide geographic disparities, with some states consistently performing better than others on the scorecard’s 42 indicators of health care access, quality, efficiency, and outcomes. The scorecard reveals that performance either declined… Show more

In the United States, where a person lives determines the kind of health care available and the length and quality of life a person is likely to enjoy. The 2014 edition of The Commonwealth Fund’s Scorecard on State Health System Performance1 documents persistently wide geographic disparities, with some states consistently performing better than others on the scorecard’s 42 indicators of health care access, quality, efficiency, and outcomes. The scorecard reveals that performance either declined or failed to improve during the 5 years up to 2012 in the majority of states on two-thirds of the 34 indicators with trend data. The findings are sobering in their portrayal of a geographic divide among state health systems. No state is making widespread progress toward the achievable outcomes that all individuals should expect considering the substantial and increasing resources devoted to health care in the United States. Show less

Case studies of three U.S. regions that ranked relatively high on the Commonwealth Fund’s Scorecard on Local Health System Performance, 2012, despite greater poverty compared with peers, revealed several common themes. In these communities, multistakeholder collaboration was an important factor in achieving community health or health system goals. There were also mutually reinforcing efforts by health care providers and health plans to improve the quality and efficiency of care, regional… Show more

Case studies of three U.S. regions that ranked relatively high on the Commonwealth Fund’s Scorecard on Local Health System Performance, 2012, despite greater poverty compared with peers, revealed several common themes. In these communities, multistakeholder collaboration was an important factor in achieving community health or health system goals. There were also mutually reinforcing efforts by health care providers and health plans to improve the quality and efficiency of care, regional investment and cooperation to apply information technology and engage in community outreach, and a shared commitment to improve the accessibility of care for underserved populations. State policy and national and local funding programs also played a role in expanding access to care and providing resources for innovation. The experiences of these regions suggest that stakeholders can leverage their unique histories, assets, and values to influence the market, raise social capital, and nudge local health systems to function more effectively. Show less

The Commonwealth Fund and the Institute for Healthcare Improvement convened 15 experts in May 2013 to help address the current controversy over the measurement of hospital readmissions. Experts agreed that Medicare should, through payment and other means, be encouraging greater coordination of care, improvement in care transitions, and mitigation of risks that leave patients vulnerable to readmission. While the current readmissions metric is undoubtedly an imperfect proxy for broader health… Show more

The Commonwealth Fund and the Institute for Healthcare Improvement convened 15 experts in May 2013 to help address the current controversy over the measurement of hospital readmissions. Experts agreed that Medicare should, through payment and other means, be encouraging greater coordination of care, improvement in care transitions, and mitigation of risks that leave patients vulnerable to readmission. While the current readmissions metric is undoubtedly an imperfect proxy for broader health system failures, it also provides a valuable foundation on which to build a better policy—one that is useful for improvement, fair for accountability, and above all, relevant to patients. Show less

The Colorado Beacon Consortium is one of 17 regions participating in the three-year, federally funded Beacon Community Program, which aims to demonstrate how strengthening local health information technology (IT) infrastructure can support improvements in the quality and efficiency of health care. The consortium sponsors a learning collaborative and coaching for 51 primary care practices in seven predominantly rural Colorado counties, helping them to build capacity for using electronic health… Show more

The Colorado Beacon Consortium is one of 17 regions participating in the three-year, federally funded Beacon Community Program, which aims to demonstrate how strengthening local health information technology (IT) infrastructure can support improvements in the quality and efficiency of health care. The consortium sponsors a learning collaborative and coaching for 51 primary care practices in seven predominantly rural Colorado counties, helping them to build capacity for using electronic health records and analytic tools and for engaging in team-based quality measurement and improvement. The region’s experience with health IT also offers insights on how community stakeholders can help spread health information exchange to improve care coordination among local "medical neighborhoods" of health care providers. Early results indicate increased provision of preventive and chronic care, improved workflow and teamwork in physician practices, and enhanced capability to prepare for health care delivery and payment reforms. Show less

Medicare has begun financially penalizing hospitals that have higher than expected rates of 30-day readmissions for select conditions. To understand the impact of the penalties, this Issue Brief synthesizes perspectives from leaders of state hospital associations, quality improvement organizations, and hospitals representing a range of performance and experiences in readmissions and their reduction. Interviewees reported the penalties have positively influenced hospital leaders’ commitment to… Show more

Medicare has begun financially penalizing hospitals that have higher than expected rates of 30-day readmissions for select conditions. To understand the impact of the penalties, this Issue Brief synthesizes perspectives from leaders of state hospital associations, quality improvement organizations, and hospitals representing a range of performance and experiences in readmissions and their reduction. Interviewees reported the penalties have positively influenced hospital leaders’ commitment to reduce readmissions and have increased transparency and cooperation to improve care transitions between acute and post-acute care providers. Concerns about the penalties, including how they are calculated, are also described. Show less

Hospital readmissions are under scrutiny by policy makers but are hardly a new problem. For more than 30 years, researchers have studied factors associated with readmission and tested care models to address these admissions, yet rates of readmissions have not declined appreciably during this time.1 The renewed focus on readmissions has been stimulated by several converging forces rather than by a strong evidence base for how improvements can be reliably achieved. US federal financial penalties… Show more

Hospital readmissions are under scrutiny by policy makers but are hardly a new problem. For more than 30 years, researchers have studied factors associated with readmission and tested care models to address these admissions, yet rates of readmissions have not declined appreciably during this time.1 The renewed focus on readmissions has been stimulated by several converging forces rather than by a strong evidence base for how improvements can be reliably achieved. US federal financial penalties for high rates of readmissions focus on hospitals as the locus of accountability for the problem, but such penalties are a weak incentive since the investment required to improve may exceed the potential loss of inpatient revenue. In this Viewpoint, we suggest that it may be more advantageous to view readmissions within a broader systems and community context that effectively engages all stakeholders to cooperatively improve outcomes. Show less

Preventable hospital admissions and readmissions are indicators of health system fragmentation associated with suboptimal patient outcomes and avoidable costs of care. Three case studies illustrate the potential of care management programs to address this problem by improving care coordination and transitions among high-risk patients. Study sites included two academic medical centers and a managed care organization owned by a home health agency. The sites employed bundles of interventions… Show more

Preventable hospital admissions and readmissions are indicators of health system fragmentation associated with suboptimal patient outcomes and avoidable costs of care. Three case studies illustrate the potential of care management programs to address this problem by improving care coordination and transitions among high-risk patients. Study sites included two academic medical centers and a managed care organization owned by a home health agency. The sites employed bundles of interventions involving multidisciplinary teams to improve provider communication, patient and family education, care transitions from the hospital, and follow-up ambulatory care. Results include a lengthening in average time between hospital encounters among asthmatic children and relative reductions in 30-day readmission rates of 46 percent among elderly patients with heart failure and of 21 percent among dually eligible Medicare and Medicaid beneficiaries with special needs. Spreading such models will likely require supportive changes in payment policy or aligned incentives between payers and providers. Show less

The National Scorecard on U.S. Health System Performance, 2011, updates a series of comprehensive assessments of U.S. population health and health care quality, access, efficiency, and equity. It finds substantial improvement on quality-of-care indicators that have been the focus of public reporting and collaborative initiatives. However, U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted… Show more

The National Scorecard on U.S. Health System Performance, 2011, updates a series of comprehensive assessments of U.S. population health and health care quality, access, efficiency, and equity. It finds substantial improvement on quality-of-care indicators that have been the focus of public reporting and collaborative initiatives. However, U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Overall, the U.S. failed to improve relative to these benchmarks, which in many cases rose. Costs were up sharply, access to care deteriorated, health system efficiency remained low, disparities persisted, and health outcomes failed to keep pace with benchmarks. The Affordable Care Act targets many of the gaps identified by the Scorecard. Show less

To illustrate the potential of organized care delivery, the Commonwealth Fund has sponsored an ongoing series of case studies of leading health care delivery organizations located across the United States that have been recognized for higher levels of performance. This chapter describes their scope, highlights how they are exhibiting the six attributes of an “ideal health care delivery system” identified by the Commission, and synthesizes key lessons from their experience.

Four case studies document the progress achieved in the past five years by health care organizations that were early leaders in patient safety improvement. Their experience reflects an expansion of interventions from individual hospital units to whole facilities and delivery systems, including new settings such as home health care. Approaches include developing practical methods for training, coaching, and motivating staff to engage in patient safety work; designing effective tools and systems… Show more

Four case studies document the progress achieved in the past five years by health care organizations that were early leaders in patient safety improvement. Their experience reflects an expansion of interventions from individual hospital units to whole facilities and delivery systems, including new settings such as home health care. Approaches include developing practical methods for training, coaching, and motivating staff to engage in patient safety work; designing effective tools and systems to minimize error and maximize learning; and leading change by setting ambitious goals, measuring and holding units accountable for performance, and sharing stories to convey values. Results include advancements in safety practices, reductions in serious events of patient harm, improved organizational safety climate and morale, and declines in malpractice claims. Keeping the commitment to patient safety has required sustained focus on making safety a core organizational value, a willingness to innovate and adapt, and perseverance in pursuing goals. Show less

Case studies of three organizations participating in the Institute for Healthcare Improvement's Triple Aim initiative shed light on how they are partnering with providers and organizing care to improve the health of a population and patients' experience of care while lowering—or at least reducing the rate of increase in—the per capita cost of care. The organizations—CareOregon, a nonprofit managed health care plan serving low-income Medicaid enrollees; Genesys Health System, a nonprofit… Show more

Case studies of three organizations participating in the Institute for Healthcare Improvement's Triple Aim initiative shed light on how they are partnering with providers and organizing care to improve the health of a population and patients' experience of care while lowering—or at least reducing the rate of increase in—the per capita cost of care. The organizations—CareOregon, a nonprofit managed health care plan serving low-income Medicaid enrollees; Genesys Health System, a nonprofit integrated delivery system in Flint, Mich.; and QuadMed, a Wisconsin-based subsidiary of printer Quad/Graphics that develops and manages worksite health clinics and wellness programs—were selected to illustrate diverse approaches. Lessons from these organizations can guide others who wish to undertake or promote transformation in health care delivery. Show less

Fifteen case studies illustrate how diverse types of organized health care delivery systems promote higher performance through information continuity, patient engagement, care coordination, team-oriented care delivery, continuous innovation and learning, and convenient access to care. Those attributes are supported by values-driven leadership, interdisciplinary teamwork, integration and aligned incentives (both at the organizational and provider level), accountability, and transparency… Show more

Fifteen case studies illustrate how diverse types of organized health care delivery systems promote higher performance through information continuity, patient engagement, care coordination, team-oriented care delivery, continuous innovation and learning, and convenient access to care. Those attributes are supported by values-driven leadership, interdisciplinary teamwork, integration and aligned incentives (both at the organizational and provider level), accountability, and transparency. Commonly reported results include improved clinical quality of care and control of chronic diseases, increased patient satisfaction, shorter waiting times, and reduced hospitalizations, emergency visits, and prescription drug expenses. The experience of these organizations supports recent recommendations by The Commonwealth Fund Commission on a High Performance Health System to stimulate greater organization of health care in the United States. Show less

Motivated by pressure and a wish to improve, health care organizations are implementing programs to improve patient safety. This article describes six natural experiments in health care safety that show where the safety field is heading and opportunities for and barriers to improvement. All these programs identified organizational culture change as critical to making patients safer, differing chiefly in their methods of creating a patient safety culture. Their goal is a safety culture that… Show more

Motivated by pressure and a wish to improve, health care organizations are implementing programs to improve patient safety. This article describes six natural experiments in health care safety that show where the safety field is heading and opportunities for and barriers to improvement. All these programs identified organizational culture change as critical to making patients safer, differing chiefly in their methods of creating a patient safety culture. Their goal is a safety culture that promotes continuing innovation and improvement, transcending whatever particular safety methodology is used. Policymakers could help stimulate a culture of safety by linking regulatory goals to safety culture expectations, sponsoring voluntary learning collaborations, rewarding safety improvements, better using publicly reported data, encouraging consumer involvement, and supporting research and education. Show less