Health Policy Center Authors
Publications by Rachel A. Burton for Health Policy Center
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More about Rachel A. Burton's areas of expertise can be found on this Urban Institute expert's page.
Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration (Research Report)
Stephen Zuckerman, Kelly J. Devers, Robert A. Berenson, Rachel A. Burton, Nicole Cafarella Lallemand, Rebecca Peters
For the past three years, Medicare, Medicaid, and private payers in eight states have been paying certified medical home practices monthly care management fees and providing additional support (e.g., data feedback, learning collaboratives, practice coaching) through the Multi-payer Advanced Primary Care Demonstration. In its first year, the demonstration included 3,800 health care providers, 700 practices, and 400,000 Medicare beneficiaries, and produced net savings for the Medicare program that totaled $4.2 million. Interviewees reported that demonstration payments provided needed support to help practices transform the way they deliver care – by adding nurse care managers, adopting electronic disease registries, and enhancing access to care after hours, as well as making other changes.
Using Qualitative Comparative Analysis (QCA) to Study Patient-Centered Medical Homes (Research Report)
Kelly J. Devers, Nicole Cafarella Lallemand, Rachel A. Burton, Stephen Zuckerman, Additional Authors
This guide provides an in-depth introduction to using qualitative comparative analysis (QCA) – an approach based on set theory and Boolean algebra – in patient-centered medical home evaluations. Specifically, QCA can be used to identify practice-level "conditions" (e.g., practice characteristics, medical home care processes) that are linked to an outcome of interest (e.g., improved care quality, higher patient satisfaction ratings, or reduced health care utilization or expenditures). The guide includes a description of key analytic steps involved in the QCA approach.
How are CHIPRA Quality Demonstration States working to improve adolescent health care? (Research Brief)
Rachel A. Burton, Ian Hill, Kelly J. Devers
Several CHIPRA Quality Demonstration states are working with participating clinicians to enhance their ability to improve the quality of health care delivered to adolescents. Specifically, North Carolina and Utah are facilitating adolescent-focused quality improvement collaboratives for primary care practices, and Colorado and New Mexico are providing support and coaching to school-based health centers serving adolescents. This Evaluation Highlight describes barriers these states encountered in their efforts to improve care for this population, identifies strategies to address these barriers, and suggests actions state Medicaid agencies could take to enhance adolescent health care.
Health Policy Brief: Improving Care Transitions (Policy Briefs)
Rachel A. Burton
The term care transition describes a continuous process in which a patient's care shifts from being provided in one setting to another, such as from a hospital to a patient's home. Poorly managed transitions can diminish health and lead to hospital readmissions, thus driving up costs for Medicare and other payers. This Health Affairs brief examines the factors contributing to poor care transitions, describes effective care delivery models aimed at improving care transitions, describes initiatives in the recent health reform law aimed at incentivizing greater attention to care transitions, and explores policy issues surrounding payment reform in this area.
Payment Reform: Bundled Episodes vs. Global Payments (Opinion)
Robert A. Berenson, Francois de Brantes, Rachel A. Burton
There is widespread agreement that the current fee-for-service approach to paying for health care is problematic, but there is a lack of consensus on what should replace it. Medicare is pursuing bundled episode payments, and proponents like Francois de Brantes of the Health Care Incentives Improvement Institute have been laying the groundwork for implementation. But other experts, such as the Urban Institute's Robert Berenson, worry that the current interest in bundled payments will distract policy-makers from moving more decisively away from fee-for-service. In this Robert Wood Johnson Foundation-funded paper, de Brantes and Berenson debate the benefits and drawbacks of bundled payments and global capitation.
Patient-Centered Medical Home Recognition Tools: A Comparison of Ten Surveys' Content and Operational Details (Research Report)
Rachel A. Burton, Kelly J. Devers, Robert A. Berenson
This report compares ten provider survey tools designed to measure the extent to which a practice is a 'patient-centered medical home' (PCMH). These tools are primarily used for recognition purposes (i.e., to qualify for entry into a payment pilot or demonstration), as opposed to for practice self-improvement, research/evaluation, or quality measurement. Our analysis, Our analysis, conducted for the Centers for Medicare and Medicaid Services, compares these ten tools' operational details (e.g., price, whether a site visit is required) and their content emphases (i.e., the different practice capabilities that the tools emphasize). We conclude by discussing issues for payers to consider when selected a PCMH recognition tool.
Health Policy Brief: Next Steps for ACOs (Policy Briefs)
Robert A. Berenson, Rachel A. Burton
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.
Accountable Care Organizations in Medicare and the Private Sector: A Status Update (Policy Briefs/Timely Analysis of Health Policy Issues)
Robert A. Berenson, Rachel A. Burton
This issue paper examines the latest developments in accountable care organizations (ACOs), including a look at the final regulations on ACOs issued in October 2011 by the Centers for Medicare & Medicaid Services (CMS). Written by the Urban Institute’s Bob Berenson and Rachel Burton, this paper provides an overview of ACOs, the key complaints about CMS' proposed regulations and their resolution in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans. This paper is supported by the Robert Wood Johnson Foundation.
Will the Patient-Centered Medical Home Transform the Delivery of Health Care? (Research Report)
Robert A. Berenson, Kelly J. Devers, Rachel A. Burton
This status report on the patient-centered medical home covers such topics as: What is a medical home? Where did the concept come from? How are medical homes assessed and paid? Do medical homes actually work? How does the health reform law encourage medical homes? The paper, funded by the Robert Wood Johnson Foundation, concludes that the medical home model has the potential to transform health care delivery, but organizations promoting the model should tread carefully because enthusiasm for the approach may not be borne out in evidence of success. Pilots should be completed and evaluated, and the model should be recalibrated before it is broadly expanded.