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The Alphabet Soup of Care Delivery Transformation

Monday, September 10, 2012

There is widespread agreement that the current health care delivery system is fragmented. Your primary care physician may be the last to know what your cardiologist is doing, or your radiologist or pharmacist, for that matter. Though the providers may be well trained and supplying good care, they are part of a system that is less than efficient, a problem that could only get worse as the population ages and chronic conditions become more prevalent.

However, change is in the works. Both the private and public sectors are testing various care delivery transformation models to improve quality, reduce morbidity and mortality, and contain the costs of treatment. They range across the spectrum of group physician practices to fully-integrated health systems. The alphabet soup includes Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs) and other models. Some new approaches, such as pay-for-performance (P4P), use the traditional fee-for-service model and include incentives for improving quality of care. Others pay medical providers in new ways.

What is a patient-centered medical home? An accountable care organization? Which care coordination models is CMS supporting? Has the Innovation Center found any promising practices that may be scalable? Have these models shown a reduction in spending? Improvements in quality of care? How is improvement being measured?

To answer these important questions and related ones, the Alliance for Health Reform and WellPoint, Inc. sponsored a September 10 briefing. Speakers were: Randall Brown, Mathematica; Arnold Milstein, M.D., Stanford University; and Leeba Lessin, CareMore, which is known for innovation in coordinating care for seniors with chronic medical conditions. Ed Howard of the Alliance and Samuel Nussbaum, M.D., of WellPoint co-moderated.


 Ed Howard, Alliance for Health Reform, Moderator
 Samuel Nussbaum, WellPoint Inc., Moderator
 Randall S. Brown, Mathematica, Speaker
 Leeba Lessin, CareMore , Speaker
 Arnold Milstein, Stanford University School of Medicine, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Briefing Transcript (Adobe Acrobat PDF), 9/10/2012
Full Webcast/Podcast: The Alphabet Soup of Care Delivery Transformation

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Nussbaum Presentation (Adobe Acrobat PDF), 9/10/2012
Brown Presentation (Adobe Acrobat PDF), 9/10/2012
Milstein Presentation (Adobe Acrobat PDF), 9/10/2012
Lessin Presentation (Adobe Acrobat PDF), 9/10/2012

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 9/10/2012
Source List (Adobe Acrobat PDF), , 9/10/2012
Speaker Biographies (Adobe Acrobat PDF), , 9/10/2012
Materials List (Adobe Acrobat PDF), , 9/10/2012

Offsite Materials (briefing documents saved on other websites)

ANA Reminds Feds of Central Role Nurses Play in Care Coordination, Advance for Nurses., 6/13/2012
The Care Coordination Imperative: Responding to the Needs of People with Chronic Diseases, The Commonwealth Fund, 2/21/2012
Care for Dual Eligibles, Health Affairs, 6/13/2012
In Massachusetts, an Accountable Care Organization that’s Actually Working, The Washington Post, 7/12/2012
Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment, Congressional Budget Office, 1/18/2012
AMA Urges CMS to Delay Dual-Eligible Demo, American Medical News, 8/3/2012
Medicaid Health Homes for Beneficiaries with Chronic Conditions (Adobe Acrobat PDF),The Kaiser Commission on Medicaid and the Uninsured, 8/1/2012
American Medical Home Runs, Health Affairs, 11/5/2009
Are Higher-Value Care Models Replicable?, , 10/20/2009
Why Accountable Care Organizations Won’t Deliver Better Health Care – and Market Innovation Will, The Heritage Foundation, 4/18/2011
NQF Endorses Care Coordination Measures, National Quality Forum, 8/10/2012
Next Steps for ACOs, Health Affairs, 1/31/2012
The Accountable Care Organization: Whatever its Growing Pains, the Concept is too Vitally Important to Fail, Health Affairs, 7/1/2011
Six Features Of Medicare Coordinated Care Demonstration Programs that Cut Hospital Admissions of High-Risk Patients, Health Affairs, 6/11/2012
Safety-Net Providers In Some US Communities Have Increasingly Embraced Coordinated Care Models, Health Affairs, 8/1/2012
Transforming Community Health Centers into Patient-Centered Medical Homes: The Role of Payment Reform, The Commonwealth Fund, 9/28/2011
Early Results Show WellPoint’s Patient-Centered Medical Home Pilots Have Met Some Goals for Costs, Utilization, and Quality, Health Affairs, 9/1/2012
Incremental Cost Estimates for the Patient-Centered Medical Home, The Commonwealth Fund, 10/16/2009
Care Coordination in Fee-for-service Medicare (Adobe Acrobat PDF),, 6/1/2012


Ed Howard of the Alliance for Health Reform moderates the discussion.

The full panel listens as Arnie Milstein makes his presentation regarding cordinated care.

Leeba Lessin, president of CareMore Medical Enterprises, explained her private Medicare health plan's approach to managing costly, frail members at the Sept. 10 briefing cosponsored by WellPoint. (Photo by James Ryder.)

Arnold Milstein, MD, of Stanford University and director of the Stanford Clinical Excellence Research Center, discussed the challenges of moving toward a health care system that pays for better quality, and warned against adapting to local clinical norms at the Sept. 10 briefing cosponsored by WellPoint. (Photo by James Ryder.) 

Randall Brown of Mathematica emphasized the need to focus on care coordination for people with chronic illness at the Sept. 10 briefing, The Alphabet Soup of Care Delivery Transformation, cosponsred by WellPoint. (Photo by James Ryder.)

Samuel Nussbaum, MD, of WellPoint, highlighted emerging relationships between insurers and medical providers at the Sept. 10 briefing cosponsored by WellPoint. (Photo by James Ryder.)


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