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Items in Brief

Experts: Move Long-Term Care to the Front Burner

More than two-thirds of respondents to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey believe it is important that the health reform plans of the presidential candidates address the quality and financing of long-term care. Ensuring adequate long-term care financing, improving the quality of services, and developing an adequate, skilled long-term care workforce are some of the urgent challenges facing the nation, said four of five opinion leaders surveyed, who included experts in health care delivery, policy, and financing. Four of five respondents also favor or strongly favor adding a long-term care benefit to Medicare, financed by a premium.

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Moving Beyond Fee-for-Service

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A Commonwealth Fund issue brief describes a promising model for reimbursing health care providers that has the potential to lower costs while also improving quality and care coordination, lowering administrative burdens, and enhancing transparency. Under the new model, developed by Prometheus Payment, providers receive "evidence-informed case rates" (ECRs)—global fees derived from the costs of treating a patient across an entire episode of care, including all recommended services delivered by physicians, hospitals, labs, and other providers. Importantly, the risk-adjusted payments factor in medical complications while at the same time holding providers accountable for the care they provide. The model's developers have found that under traditional fee-for-service, potentially avoidable complications account for a high proportion of the total costs of care—some 30 percent of payments for acute myocardial infarction and 60 percent for diabetes care, according to lead author François de Brantes.

Colocated Health Services Offer Parents 'One-Stop Shopping'

Pediatric practices wishing to strengthen their capacity to serve as medical homes may want to consider having other practitioners and service providers colocate, so that families—particularly those with children who have developmental problems or chronic conditions—have access to a variety of services under one roof. A Commonwealth Fund issue brief shows that by making such services as mental health care and nutritional counseling available in the same care setting, a practice will be better equipped to address families' overlapping needs and help parents navigate an often complex and fragmented health care delivery system.

Embracing Accountable Health Care

Aligning physician practice with evidence-based medicine sounds simple enough, but it is a challenge that has long frustrated many health care systems. In a new case study published by The Commonwealth Fund, Ann Lennarson Greer of the University of Wisconsin-Milwaukee tells the story of how the Wisconsin Collaborative for Healthcare Quality has used public reporting of performance data as a tool to jumpstart the learning and quality improvement process—and how it has put into place a dynamic model for translating evidence-based medicine into community practice. Early efforts have targeted common ambulatory conditions like diabetes that are treatable but costly. Currently, the consortium reports data for more than 50 percent of Wisconsin primary care physicians, with a goal of 75 percent by 2010.

Fund Podcast Focuses on Culture Change in Nursing Homes

In a new episode of New Directions in Health Care: The Commonwealth Fund Podcast, Emily Schifrin explores how a long-term care system in New York is creating "an environment for living" for its residents. Through interviews with leadership, staff, and residents, Schifrin explores how "culture change" is helping to transform life at the Sarah Neuman Center in Mamaroneck, New York, and at Jewish Home Lifecare's Manhattan and Bronx campuses by deinstitutionalizing the physical environment, dining facilities, and staffing structure.

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