The Move to Medical Homes and Accountable Care

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Two of the most promising approaches for improving the quality and efficiency of health care in the United States are the patient-centered medical home and the accountable care organization, both of which have been gaining traction in recent years. In the new issue of <em>Health Affairs</em>, Commonwealth Fund–supported researchers examine efforts to implement and spread these models for delivering effective care. <br /><br />
<a href="/publications/journal-article/2012/nov/about-half-states-are-implementing-patient-centered-medical">About Half of the States Are Implementing Patient-Centered Medical Homes for Their Medicaid Populations</a>, by Mary Takach <br />
Over the past six years, Medicaid agencies in 25 states have pursued initiatives to incentivize and support physician practices to become patient-centered medical homes, where clinicians and other health professionals team up to provide comprehensive, coordinated, accessible services to their low-income patient populations. Mary Takach, program director at the National Academy for State Health Policy, reviews the variety of reforms taking shape, including new fee structures that enable physician practices to be reimbursed for the care management services they provide; support for smaller practices to share the services of registered nurses, behavioral health specialists, and other health professionals; and the alignment of payment with quality-of-care standards. <br />
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<a href="/publications/journal-article/2012/nov/insights-transformations-under-way-four-brookings-dartmouth">Insights from Transformations Under Way at Four Brookings–Dartmouth Accountable Care Organization Pilot Sites</a>, by Bridget K. Larson and colleagues <br />
Accountable care organizations, which seek to balance cost control with efforts to improve health outcomes and enhance patients' satisfaction with care, have begun to take hold in both the private and public sectors. Little is known, however, about how ACOs form and what conditions are necessary for their success. Based on their study of four ACO pilot sites from the Brookings–Dartmouth ACO Collaborative, the researchers say it is critically important for health care providers to form new collaborative relationships with payers, and for shared savings to be closely linked to performance on quality measures. <br />
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<a href="/publications/journal-article/2012/nov/framework-evaluating-formation-implementation-and-performance">A Framework for Evaluating the Formation, Implementation, and Performance of Accountable Care Organizations</a>, by Elliott S. Fisher and colleagues <br />
Dartmouth researchers examine early tracking data to identify clues to the successful development of accountable care organizations and then propose a framework for evaluating these new health care organizations. Following a "balanced scorecard" approach, the framework includes measures in three categories: ACO contract characteristics; structure, capabilities, and activities; and local context. <br />