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Accountable Care: Building Systems for Population Health Management

October 6, 2014

This case study series describes how three diverse organizations are developing accountable care systems to improve the quality and reduce the costs of care, and ultimately improve the health of populations of patients insured by Medicare, Medicaid, and commercial health plans. They employ a constellation of strategies to identify and address unmet medical needs, improve care transitions, and reduce inefficiencies and unnecessary variation in care. Care managers, outreach workers, or virtual care teams help improve outcomes for patients with complex needs that are costly to treat. Data integration and analytics are key to their efforts, although the sophistication of these capabilities varies. Two study sites have established a record of savings, while the third is still proving the potential of its approach. Their progress to date suggests that payment reforms can foster the will and accountability necessary to transform care.

Marshfield Clinic: Demonstrating the Potential of Accountable Care

October 6, 2014

Marshfield Clinic, a nonprofit multispecialty group practice in central Wisconsin, joined Medicare's Shared Savings Program in 2013, following its success in Medicare's Physician Group Practice demonstration—the program's forerunner. The clinic's Medicare ACO benefits from the organization's past investment in advanced primary care infrastructure and disease-specific care management capabilities, which have yielded reductions in hospitalization and readmission rates. The clinic has an advanced, internally developed electronic health record system and enterprise data warehouse, which allow internal performance reporting and identification of best practices that have galvanized physician support for quality improvement efforts. Marshfield Clinic's track record of achieving cost savings and quality targets set by Medicare suggests the importance of combining missiondriven performance improvement initiatives with a commitment to mutual accountability among providers in group practice.

Health Share of Oregon: A Community-Oriented Approach to Accountable Care for Medicaid Beneficiaries

October 6, 2014

Health Share of Oregon is a nonprofit founded in 2012 to coordinate the provision of medical, dental, and behavioral health care for Medicaid beneficiaries in a tricounty region encompassing Portland. As one of 16 coordinated care organizations designated by the state to oversee and improve the delivery of these services for a geographically defined population, it receives a global budget. It distributes per-capita payments to health plans— some of which are integrated delivery systems—and county-run mental health agencies that have agreed to accept risk for providing or ensuring access to defined services. These risk-bearing entities—all founders of Health Share—serve on its governing board, along with representatives of community-based organizations and social service agencies committed to this population. Health Share brings these stakeholders together to improve care for high-need, high-cost patients; achieve efficiencies by centralizing certain administrative and enrollment functions; and create accountability for performance.

Hill Physicians Medical Group: A Market-Driven Approach to Accountable Care for Commercially Insured Patients

October 6, 2014

Hill Physicians Medical Group—Northern California's largest independent practice association (IPA)—joined local hospitals and commercial health plans in forming four separate accountable care organizations (ACOs) aimed at improving quality, reducing fragmentation, and lowering the cost of care as a means of retaining business. This profile focuses on the first and largest ACO, which was established in January 2010 to reduce premiums for 41,000 public sector employees and retirees covered by the California Public Employees' Retirement System (CalPERS). The ACO has decreased hospital use and permember per-month spending in its first three years, resulting in $59 million in savings to CalPERS or $480 per member per year. Leaders credit success to developing a mutual understanding of one another's strengths and challenges, which was a prerequisite for improving care coordination, increasing patient education, and reducing unwarranted variations in care.

Opportunity for Regional Improvement: Three Case Studies of Local Health System Performance

April 17, 2014

Case studies of three U.S. regions that ranked relatively high on the Commonwealth Fund's Scorecard on Local Health System Performance, 2012, despite greater poverty compared with peers, revealed several common themes. In these communities, multistakeholder collaboration was an important factor in achieving community health or health system goals. There were also mutually reinforcing efforts by health care providers and health plans to improve the quality and efficiency of care, regional investment and cooperation to apply information technology and engage in community outreach, and a shared commitment to improve the accessibility of care for underserved populations. State policy and national and local funding programs also played a role in expanding access to care and providing resources for innovation. The experiences of these regions suggest that stakeholders can leverage their unique histories, assets, and values to influence the market, raise social capital, and nudge local health systems to function more effectively.

Grand Rapids and West Central Michigan: Pursuing Health Care Value through Regional Planning, Cooperation, and Investment

April 17, 2014

The region of West Central Michigan encompassing Grand Rapids and surrounding communities ranks in the top quartile among 306 U.S. regions evaluated by The Commonwealth Fund's Scorecard on Local Health System Performance, 2012, performing especially well on measures of prevention and treatment quality, avoidable hospital use, and costs of care. This relatively higher performance may stem from the area's conservative medical practice style and local stakeholders' stewardship of community health and health care, as illustrated by a long history of regional planning and accountability for promoting the efficient use of resources. Complementary efforts and incentives to improve quality of care, community outreach programs, and a commitment to strengthening the safety net also may influence regional performance. However, more recently, rising costs and increasingly competitive market dynamics appear to be challenging the social contract that has long guided community cooperation.

Buffalo and Western New York: Leveraging Social Capital to Collaboratively Improve Health System Performance

April 17, 2014

The western region of New York State encompassing Buffalo and surrounding counties ranks in the top quartile among 306 U.S. regions evaluated by The Commonwealth Fund's Scorecard on Local Health System Performance, 2012, performing especially well on measures of access, prevention, and treatment. Its relatively strong performance may reflect the collective impact of partnerships of local nonprofit health plans and physicians to improve quality; the development of a regional health information exchange that enables the sharing of clinical and administrative health care data among hospitals, physicians, and insurers; and the cooperation of community foundations and nonprofit organizations in conceiving a strategic vision for addressing unmet health care needs. An exemplar of the region's approach is the P2 Collaborative of Western New York, a "coalition of coalitions" that convenes community stakeholders to advance population health programs and efforts to transform clinical practice.