Key to Health Care Reform: Changing How Care is Delivered

The article focuses on the lack of provisions of the 2010 Patient Protection and Affordable Care Act (PPACA) for controlling the rising costs of health care despite insurance coverage for more Americans. Successful health care reform must reportedly aim to improve the quality, outcomes and patient\u27s experience of care in order to improve the overall health of the population and slow down costs. The framework to achieve a fundamental change in health care delivery is presented

Key to Health Care Reform: Changing How Care is Delivered

The article focuses on the lack of provisions of the 2010 Patient Protection and Affordable Care Act (PPACA) for controlling the rising costs of health care despite insurance coverage for more Americans. Successful health care reform must reportedly aim to improve the quality, outcomes and patient\u27s experience of care in order to improve the overall health of the population and slow down costs. The framework to achieve a fundamental change in health care delivery is presented

Accountable Care Organizations in California: Promise and Performance

California has more accountable care organizations (ACOs) than any other state in the country, with particularly rapid growth over the past two years. This report introduces new evidence that ACOs improve the quality of care, increase patient satisfaction, and may reduce costs

Decision Aid Implementation and Patients' Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative.

Background:Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters. Objective:In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients' treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations. Design:Retrospective cohort study. Setting:10 High Value Healthcare Collaborative (HVHC) health systems. Study participants:A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015. Results:Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations. Conclusion:Patients' treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs

Multi-Sectoral Partnerships and Patient-Engagement Strategies in Accountable Care Organizations

Background: Patient-engagement strategies are increasingly recognized for enriching traditional medical care and improving population health. Accountable Care Organizations (ACOs) may be well positioned to leverage multi-sector organizational partnerships to improve the reach of their patient-engagement strategies, particularly given incentives to meet cost, quality and population health goals. Little is currently known about the relation of multi-sector partnerships and patient engagement in ACOs. Purpose: To examine the relation of patient-engagement strategies and breadth of multi-sectoral organizational partnerships in 71 primary care practices affiliated with one of two ACOs. Methods: Clinical and administrative leaders from each practice were surveyed. Questions assessed practice use of 12 different partnership sectors and the adoption of 14 patient-engagement strategies. Bivariate tests examined associations between patient-engagement strategies and practice use of partnership sectors. Multivariate linear regression estimated the extent to which practices with a greater number of multi-sector organizational partnerships had greater adoption of patient-engagement strategies. Results: Practices reported partnering with a mean of 3.2 (standard deviation, SD= 2.1) out of 12 sectors and implementing a mean of 7.1 (SD=3.4) out of 14 patient-engagement strategies. Each additional type of multi-sector partnership was associated with greater adoption of patient-engagement strategies (β = 0.59, 95% CI = 0.23–0.95, for all partnerships and β = 0.92, 95% CI = 0.42–1.43, when restricted to nonmedical partnerships) Implications: Practices with a greater breadth of multi-sector partnerships, particularly nonmedical partnerships, use a wider range of strategies to engage patients in their own care

How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points.

ObjectiveIf patient engagement is the new 'blockbuster drug' why are we not seeing spectacular effects? Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organisations (ACO). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown. We assessed the use and understanding of patient engagement approaches among frontline clinicians and managers at ACO-affiliated practices.DesignQualitative study; 103 in-depth, semi-structured interviews.ParticipantsSixty clinicians and eight managers were interviewed at two established ACOs.ApproachWe interviewed healthcare professionals about their awareness, attitudes, understanding and experiences of implementing three key approaches to patient engagement and activation: 1) goal-setting, 2) motivational interviewing and 3) shared decision making. Of the 60 clinicians, 33 were interviewed twice leading to 93 clinician interviews. Of the 8 managers, 2 were interviewed twice leading to 10 manager interviews. We used a thematic analysis approach to the data.Key resultsInterviewees recognised the term 'patient activation and engagement' and had favourable attitudes about the utility of the associated skills. However, in-depth probing revealed that although interviewees reported that they used these patient activation and engagement approaches, they have limited understanding of these approaches.ConclusionsWithout understanding the concept of patient activation and the associated approaches of shared decision making and motivational interviewing, effective implementation in routine care seems like a distant goal. Clinical teams in the ACO model would benefit from specificity defining key terms pertaining to the principles of patient activation and engagement. Measuring the degree of understanding with reward that are better-aligned for behaviour change will minimise the notion that these techniques are already being used and help fulfil the potential of patient-centred care

Financial Incentives and Physician Practice Participation in Medicare’s Value‐Based Reforms

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145327/1/hesr12743_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145327/2/hesr12743-sup-0001-AppendixSA1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145327/3/hesr12743.pd