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Fredrika Scarth

2019–20 Canadian Harkness/CFHI Associate in Health Care Policy and Practice Director, Secretariat, Premier’s Council on Improving Healthcare and Ending Hallway Medicine Ontario Ministry of Health and Ministry of Long-Term Care

Fredrika Scarth

Mentor: Hoangmai Pham, M.D., M.P.H., Vice President, Anthem Provider Solutions, Anthem Inc.

Project: Enabling Accountable Care: State Interventions to Support Accountable Care Reform         

Fredrika Scarth, Ph.D., M.A., is a 2019–20 Canadian Harkness/CFHI Associate in Health Care Policy and Practice. As the director of the Secretariat on Improving Healthcare and Ending Hallway Medicine in the Ontario Ministry of Health, Scarth works with a special advisor and council reporting directly to the premier of Ontario and ministers of health and long-term care, with a broad mandate to make strategic recommendations to government that will shape the future directions of health care in the province, including structural and other reforms to support greater integration in health care delivery. Scarth has previously held senior roles within the Ministry of Health and Long-Term Care, leading the design and implementation of provincial programs focused on improving patient outcomes and experience and addressing system costs, including integrated service delivery in rural areas and bundled payment for acute and postacute care. She has led clinical and expert panel processes and acted as a decision-maker partner on international research grants focused on integrated care, transitions in care, and avoidable hospitalization. Scarth received her Ph.D. in political theory from the University of Toronto, her M.A. in political science from the University of Toronto, and a B.A. in political science from McGill University.

Project Overview: The potential of accountable care organizations (ACOs) to improve quality and moderate increases in health care costs is beginning to be understood in the U.S., but lessons that might apply in other jurisdictions have not yet been explored in depth. Ontario has recently announced it will implement broad payment and structural reforms to enable integrated systems of care delivery, supported through aligned payment incentives and accountability for care quality and cost. This research project will seek to understand the interventions at the U.S. state level that have created and sustained accountable care implementation, and assess which of these interventions are most likely to be effective in a single-payer universal health care system, such as Ontario’s. The study will be based on qualitative research conducted in select states that have used Medicaid waivers (1115 waivers) to enable payment and service delivery reform. It will explore the jurisdictional level (e.g., legislation, payment reform, policy) and local or organizational levels (e.g., local relationships, local leadership, and clinical engagement) through interviews with state policymakers and clinical leadership of the selected programs, as well as in-depth case studies.