21st-Century Health Care — The Case for Integrated Delivery Systems

Crosson, Francis J.

doi:10.1056/nejmp0906917

Cited by 54 publications

(38 citation statements)

References 2 publications

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“…For example, recent publications report on primary care efforts within integrated systems, whereby practices succeeded in improving measures of patient experience, medical record audits, and work satisfaction. 14,33,68 As the PCMH concept continues to evolve, the NDP experience reminds us that practice redesign requires a systems perspective. Although limiting the scope or focus of an intervention is attractive from a project management perspective, those contemplating PCMH interventions should be aware of the limitations of underfunded pilot projects that focus only on parts of the PCMH, overemphasize measures for managing chronic disease, or run for less than 2 years.…”

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confidence: 99%

Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

Crabtree¹,

Nutting²,

Miller³

et al. 2010

The Annals of Family Medicine

207

186

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This article summarizes fi ndings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patientcentered medical homes (PCMHs) based on these fi ndings and an understanding of diverse efforts to transform primary care.The NDP was launched in June 2006 as the fi rst national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peerreviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated?We fi nd that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefi ts from external support. Most practices will need additional resources for this magnitude of transformation.Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for suffi cient resources for implementing personal and practice development plans. In the meantime, we fi nd that much can be done before larger health system reform. INTRODUCTIONE merging consensus among policy makers, professional organizations, clinicians, and payers bears witness that health care in the United States has reached a defi ning moment. 1 The landmark 2001 Institute of Medicine report Crossing the Quality Chasm called for extensive overhaul and redesign of US health care.2 The patient-centered medical home (PCMH) is a popular model that proponents hope addresses many of the concerns raised in that report. [3][4][5][6][7] The PCMH concept is endorsed by the major primary care professional organizations, who issued a joint statement on principles of the PCMH in 2007, emphasizing patients' ongoing relationship with a personal physician; team approaches to care; a wholeperson orientation; mechanisms to support care integration, quality, safety and access; and payment for added value. 8 During the past several years, a growing number of PCMH demonstration projects have been undertaken. 9 Some of these focus on chronic care. [9][10][11] Most are regional in scope 9,10,12 or are conducted within a particular integrated health care system. 9,[13][14][15] Relatively few both are comprehensive in scope and include diverse, especially small, independent practices. 9,16 The National Demonstration Project (NDP) launched by the American Academy of Family Physicians (AAFP) S81NDP SU M M A RY A ND R ECO M MENDAT IONS F OR P C MH demonstration project on a national sample of practices designed to test a comprehensive model of the PCMH envisioned by the Future of Family Medicine report. 17In...

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confidence: 99%

Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

Crabtree¹,

Nutting²,

Miller³

et al. 2010

The Annals of Family Medicine

207

186

View full text Add to dashboard Cite

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“…Under the accountable care model, provider groups or affiliations assume responsibility for the quality and cost of care for the patient populations they serve, sharing in any savings generated if defined quality targets are met. [6][7][8][9][10][11][12][13][14][15][16][17][18] The Affordable Care Act authorized the Centers for Medicare and Medicaid Services to create accountable care programs that sought either to reduce spending while maintaining care quality or to improve quality at no increased cost. 12,[16][17][18] Even before the act's passage, demonstration projects that used accountable care principles were under way.…”

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confidence: 99%

A Collaborative Accountable Care Model In Three Practices Showed Promising Early Results On Costs And Quality Of Care

et al. 2012

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Cigna's Collaborative Accountable Care initiative provides financial incentives to physician groups and integrated delivery systems to improve the quality and efficiency of care for patients in commercial open-access benefit plans. Registered nurses who serve as care coordinators employed by participating practices are a central feature of the initiative. They use patient-specific reports and practice performance reports provided by Cigna to improve care coordination, identify and close care gaps, and address other opportunities for quality improvement. We report interim quality and cost results for three geographically and structurally diverse provider practices in Arizona, New Hampshire, and Texas. Although not statistically significant, these early results revealed favorable trends in total medical costs and quality of care, suggesting that a shared-savings accountable care model and collaborative support from the payer can enable practices to take meaningful steps toward full accountability for care quality and efficiency.

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“…5,7 Some of the inefficiencies of the current US health care delivery system stem from the growth of new and expensive medical technologies and the fee-for-service payment of physicians. 8 Although physicians aim to provide patient care on the basis of scientific evidence, financial considerations may influence their treatment decisions. Replacement of fee-for-service with capitated payment has been proposed as one way to improve the efficiency of health care delivery.…”

Section: Introductionmentioning

confidence: 99%

“…Previous research has shown that although prospective payment has slowed the growth of health care spending at the medical group level, similar results have not been achieved among individual or small practices. 8 Physician practices therefore may need to be reorganized and integrated across multispecialty groups and hospitals to be responsive to new payment methods. Thus, health care reform efforts also may need to focus on redesigning integrated systems of care.…”

Section: Introductionmentioning

confidence: 99%

Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review

Maeda¹,

Lee

Horberg³

2014

TPJ

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21st-Century Health Care — The Case for Integrated Delivery Systems

Cited by 54 publications

References 2 publications

Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

A Collaborative Accountable Care Model In Three Practices Showed Promising Early Results On Costs And Quality Of Care

Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review

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