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

Evaluation of Patient to Provider Oriented Telemedicine in Hospitals and Physician Practices

This project explores barriers to telemedicine adoption and meaningful integration with contemporary healthcare delivery systems

No VIP Treatment: ACOs Should Not Get Waiver Protection from the Prohibition on Beneficiary Inducement

Virgil is known for saying the greatest wealth is health. \u27 Based on the astronomical amount spent on healthcare, the United States has taken his idea literally-spending more wealth will lead to greater health. In 2006, the United States spent over seven thousand dollars per person annually on healthcare. While that number may not seem very high to spend on an individual level, the total amounted to approximately 2.1 trillion dollars in 2006. In 2014, that number hit three trillion, or seventeen percent of the country\u27s Gross Domestic Product ( GDP ). One justification for spending nearly one-fifth of the United States GDP on health care is that high quality health outcomes will result. However, this causal leap depends on the assumption that spending more money on healthcare automatically leads to high quality, which is simply not the case

Integrating Behavioral Health & Primary Care in New Hampshire: A Path Forward to Sustainable Practice & Payment Transformation

New Hampshire residents face challenges with behavioral and physical health conditions and the interplay between them. National studies show the costs and the burden of illness from behavioral health conditions and co-occurring chronic health conditions that are not adequately treated in either primary care or behavioral health settings. Bringing primary health and behavioral health care together in integrated care settings can improve outcomes for both behavioral and physical health conditions. Primary care integrated behavioral health works in conjunction with specialty behavioral health providers, expanding capacity, improving access, and jointly managing the care of patients with higher levels of acuity In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative (Initiative) created the NH Behavioral Health Integration Learning Collaborative (BHI Learning Collaborative) in November of 2015, as a project of its Accountable Care Learning Network (NHACLN). Bringing together more than 60 organizations, including providers of all types and sizes, all of the state’s community mental health centers, all of the major private and public insurers, and government and other stakeholders, the BHI Learning Collaborative built on earlier work of a NHACLN Workgroup focused on improving care for depression and co-occurring chronic illness. The BHI Learning Collaborative design is based on the core NHACLN philosophy of “shared data and shared learning” and the importance of transparency and open conversation across all stakeholder groups. The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service (FFS) revenues. Provider members joined either a Project Implementation Track working on quality improvement projects to improve their levels of integration or a Listen and Learn Track for those just learning about Behavioral Health Integration (BHI). Providers in the Project Implementation Track completed a self-assessment of levels of BHI in their practice settings and committed to submit EHR-based clinical process and outcomes data to track performance on specified measures. All providers received access to unblinded NHACLN Primary Care and Behavioral Health attributed claims data from the NHCHIS for provider organizations in the NH BHI Learning Collaborative. Following up on prior work focused on developing a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings, the BHI Learning Collaborative engaged consulting experts and participants in understanding challenges in Health Information Technology and Exchange (HIT/HIE), privacy and confidentiality, and workforce adequacy. The BHI Learning Collaborative identified a sustainable payment model for integrated care of depression in primary care. In the process of vetting the payment model, the BHI Learning Collaborative also identified and explored challenges in payment for Substance Use Disorder Screening, Brief Intervention and Referral to Treatment (SBIRT). New Hampshire’s residents will benefit from a health care system where primary care and behavioral health are integrated to support the care of the whole person. New Hampshire’s current opiate epidemic accentuates the need for better screening for behavioral health issues, prevention, and treatment referral integrated into primary care. New Hampshire providers and payers are poised to move towards greater integration of behavioral health and primary care and the Initiative looks forward to continuing to support progress in supporting a path to sustainable integrated behavioral and primary care

Organizational Improvement Readiness Assessment (OIRA) Tool Evaluation

Background: Research shows that despite an increase in the number of organizational improvement initiatives there is a lack of consistent, sustained outcomes. Organizations struggle with how to reliably and accurately measure their readiness to drive and sustain outcomes. A search of the literature failed to identify a comprehensive, evidence-based tool that has been developed or evaluated to assess organizational improvement readiness. The objective of this project was to evaluate a newly developed Organizational Improvement Readiness Assessment (OIRA) Tool. Project Design: Guided by two theoretical models, Delphi-Based Systems Architecting Framework (DB-SAF) and the Rogers Diffusion of Innovation Model, a 3-round, modified Delphi nominal group method was utilized. An evaluation panel of 13 organizational improvement subject matter experts (SMEs) was recruited, with 11 SMEs completing all 3 evaluation rounds. The relevancy and clarity of the OIRA Tool competencies was evaluated using an item-level content validity index (I-CVI) and a scale-level content validity index (S-CVI). Additionally, the tool was evaluated from a usability perspective using Google Analytics. Results: The OIRA Tool was found to be clear, understandable, and relevant for organizations evaluating their readiness to drive and sustain outcomes improvements (S-CVI index of 0.92 and I-CVI indices ranging from 0.82 to 1.0). The final version of the tool included 22 competencies, modified based on expert consensus from the original 25. Usability test results confirmed the OIRA Tool, a web-based tool, is easy to use and well designed as measured by exit rates (15.44%), bounce rates (51.81%), and conversion rates (14%), all of which were significantly better than industry benchmarks. Recommendations and Conclusions: Results of this project provide evidence of the content validity and usability of the OIRA Tool. The tool has the potential to help healthcare organizations assess their readiness to sustain organizational improvements and to identify gaps in leadership and culture, processes, technologies, and standards. The OIRA Tool provides the foundation for future analytics modeling and additional studies to test the theory and the advancement of outcomes improvement science

Health Information Technology in the United States: Driving Toward Delivery System Change, 2012

Examines progress on electronic health record adoption, health information exchange under the HITECH Act, and models for meaningful delivery system reform through health information technology. Includes interview with former national HIT coordinator