Health Care Systems and HMOs

This Health Affairs brief provides an overview of accountable care organizations (ACOs), which are networks of physicians and other providers that agree to be held accountable for the cost and quality of the full continuum of care delivered to a group of patients. The brief covers the origins of the ACO concept, describes what makes ACOs different from existing health plans and provider arrangements, and summarizes the current status of adoption by Medicare and private health insurance plans. It also notes that based on the results of a five-year demonstration, ACOs will likely be able to improve clinical care quality but may have a harder time generating meaningful savings.

This Robert Wood Johnson Foundation-funded paper by Robert Berenson and Nicole Cafarella provides a status report on the Innovation Center's activities to date—including delineating the goals envisioned by Congress, detailing the new tools it was given, and emphasizing how the enhanced authority compares with CMS’s traditional demonstration programs. The paper describes the Center's major initiatives to date, including those that address primary care redesign, bundled payments, ACOs, dual-eligible beneficiaries, and the health care system's capacity for spreading innovative ideas. The authors note that some observers have expressed concern that the Innovation Center's fast-paced approach may be overwhelming to smaller delivery systems.

The United States has embarked on a major effort to achieve "meaningful use" of health information technology (HIT) by clinicians and hospitals. This paper, from The Commonwealth Fund's international program, describes meaningful use in three countries with very high levels of HIT adoption—Denmark, New Zealand, and Sweden. None has reached 100 percent in all meaningful use categories, but providers share many kinds of information with other health care organizations and health authorities. Less information is shared with patients. Useful strategies have included providing economic incentives to encourage adoption and designating an organization to take responsibility for standardization and interoperability.

This policy paper by Kelly Devers analyzes the trend toward quality improvement (QI) efforts in health care, concluding that while QI alone is no magic bullet, it generally has modest, positive effects. The paper, funded by the Robert Wood Johnson Foundation, reviews the evolution of QI initiatives, the current evidence about whether QI interventions work, QI’s promise for the future, and how to help it find success in health care. The paper offers recommendations for enhancing QI, including by providing incentives for providers to prioritize quality; improving education, training, and technical assistance; investing in health IT; and promoting greater collaboration across organizations.

This paper, from The Commonwealth Fund’s international program, examines the origins, content, and potential impact of England's evidence-based End-of-Life Care Strategy. Challenges addressed include moving such care beyond the province of hospice and palliative-care specialists and initiating palliative services before the patient's final days. Aspects of the English approach that may be useful in the U.S include helping physicians recognize when patients are entering a trajectory that may end in death, the use of "death at home" as a metric for measuring progress, improving the skills of clinical and caregiving personnel through Web-based training, and developing a national improvement pathway.