Norton Healthcare: A Strong Payer-Provider Partnership for the Journey to Accountable Care

Examines the progress of an integrated healthcare delivery system in forming an accountable care organization with payer partners as part of the Brookings-Dartmouth ACO Pilot Program, including a focus on performance measurement and reporting

HealthCare Partners: Building on a Foundation of Global Risk Management to Achieve Accountable Care

Describes the progress of a medical group and independent practice association in forming an accountable care organization by working with insurers as part of the Brookings-Dartmouth ACO Pilot Program. Lists lessons learned and elements of success

On the Road to Better Value: State Roles in Promoting Accountable Care Organizations

Outlines how accountable care organizations can deliver value through incentives to manage utilization, improve quality, and curb cost growth. Profiles states supporting the model with data, new payment methods, accountability measures, and other efforts

Emerging Medicaid Accountable Care Organizations: The Role of Managed Care

Examines the Medicaid payment and care delivery systems in states working to develop accountable care organizations within Medicaid, how ACOs may be structured to fit into them, and how Medicaid ACOs differ from those in Medicare and the private market

Planning a Better Future for Dual Eligible Elderly in Montgomery County

Older adults who are dual eligible (who qualify for both Medicare and Medicaid) face a daunting gauntlet of challenges in healthcare. Despite comprehensive coverage through Medicare and Medicaid, the lack of coordination between the two systems creates often insurmountable problems of access and delivery. Federally-funded Medicare lacks coordination and integration with federal-state funded Medicaid. Ironically, it is these dual eligible individuals who so desperately need healthcare since they have a higher incidence of cognitive impairment (including Alzheimer's Disease), mental disorders, diabetes, pulmonary disease and strokes. Further, they are more vulnerable and frail, have lower incomes, and are more isolated than are non-dual eligible elderly. These problems, in turn, contribute to significant challenges with housing, food and transportation. The challenges with access to care are tragic, expensive and avoidable.The high care needs of dual eligible individuals and the associated costs have driven states and the federalgovernment to seek ways to better integrate and coordinate their care. The Affordable Care Act (2010) is teemingwith initiatives, demonstrations, and new opportunities premised on finding a way to better meet dual eligibleindividuals' healthcare needs at a cost-effective rate. While little has yet been done at the state level, localproviders are starting to test innovative approaches to delivering better care to dual eligible individuals.This report summarizes state and federal initiatives and opportunities for delivering better care to dual eligible elderly. It also presents the efforts underway at the County level and by local providers. Following the informational section of the report, the Workgroup presents nine systems change recommendations to better improve the care provided to Montgomery County's dual eligible elderly. The recommendations may stand alone, each reflecting their own systems change, or may be combined in a more encompassing effort at service delivery system overhaul.There are numerous federal opportunities for delivering better care to frail populations. Some of them are specifically targeted towards the dual eligible population and others are targeted towards other populations, but include a considerable number of dual eligible individuals. In the report, we describe five different types ofapproaches and describe examples of each

Promising Payment Reform: Risk-Sharing With Accountable Care Organizations

Describes the implementation of shared payer-provider risk payment models at eight private accountable care organizations. Analyzes challenges for providers, purchasers, and payers, including securing the infrastructure for successful risk management

Health Care Opinion Leaders' Views on Delivery System Innovation and Improvement

Presents survey results on healthcare experts' views on strategies and models for fostering coordination and integration, such as accountable care systems, medical homes, and bundled payments; priorities among reform provisions; and market concerns

The Group Employed Model as a Foundation for Health Care Delivery Reform

Outlines group employed models, with salaried primary and specialty care physicians and quality of care- and satisfaction-based incentives as high-quality, low-cost alternatives to fee-for-service; elements of success; and implications beyond Medicare

Doing Better by Doing Less: Approaches to Tackle Overuse of Services

Experts have projected that as much as a third of U.S. health care spending is unnecessary and wasteful. Of the estimated $765 billion of health care dollars wasted in 2009, a quarter --$210 billion -- was spent on the overuse of services, which includes services that are provided more frequently than necessary or services that are higher-cost, but no more beneficial than lower-cost alternatives.This paper provides a summary of the problem of overuse in the U.S. health care system. The analysis gives an overview of the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients' health outcomes. It also describes approaches that have already been used to address overuse of health care services and outlines the broader payment reforms needed to minimize incentives to overdiagnose and overtreat.This overuse of services has implications for both health care costs and outcomes. There is substantial variation in the level of inappropriate use across different health care services. Research shows that the rates at which particular procedures, tests, and medications were performed or prescribed when clinically inappropriate ranged from a low of 1 percent to a high of 89 percent