These projects are designed to contribute to the body of literature and quantitative data analyzing the performance of accountable physician practices in the delivery of high quality and efficient care.
Dartmouth Group Practice Performance Study
In 2006, CAPP launched a study to analyze linked data from (1) CAPP multi-specialty group practices; (2) Medicare claims from Dartmouth’s Medicare fee-for-service claims database; and (3) National Survey of Physician Organizations (NSPO) NSPO1 and NSPO2 data on organizational attributes and care management processes at these organizations. The study provides insight into differences in performance across these organizations and the association between better performance and the presence of specific organizational attributes and specific care management processes. In addition, the study compares the performance of CAPP groups to other providers within their hospital markets. The research was led by Elliott Fisher, MD, of the Dartmouth Center for Evaluative Clinical Sciences; Larry Casalino, MD, of Weill Cornell Medical College and New York-Presbyterian Hospital; and Stephen Shortell, PhD, of University of California, Berkeley. The study provides further evidence that large multispecialty groups and organized health care delivery systems deliver higher quality care at a lower cost than other providers in their market regions. This information is valuable in light of current health care reform and delivery system reform efforts.
STATUS: The paper was published in May, 2010 in Health Affairs.
Capitation and Salary Study
Many policy analysts have advocated for modifying current methods of paying for medical services away from fee-for-service and towards bundled payments for defined episodes of care or global capitation. In collaboration with the Heller School of Management at Brandeis University, CAPP is launching a project to estimate the prevalence and magnitude of capitation and other alternative payment contracts among organized delivery systems that are members of CAPP, to understand these groups’ previous experience and learning related to various payment methods, and to understand the approaches to physician compensation utilized by these groups. This study will provide a barometer of the "readiness" for payment reform among organized medical groups and identify key issues they must address to advance their state of preparation.
STATUS: This project has received funding from the Commonwealth Fund.
These projects were designed to support policy positions or further the knowledge base about how multi-specialty medical groups provide care.
"Partners in Health: How Physicians and Hospitals Can Be Accountable Together"
The concept of "accountable care organizations" has gained traction with the current health insurance reform debate, and there is increasing acceptance among industry leaders that care coordination that comes from system integration is necessary to achieve both the cost and quality goals of health reform. In light of these trends, a state-of-the-art book on physician-hospital integration (the centerpiece of delivery system reform) is not only timely but will be of great value as the debate progresses and pilot projects are developed. To this end, CAPP with the Kaiser Permanente Institute of Health Policy identified expert authors to collaborate on such a publication.
STATUS: The book has been published by Jossey-Bass (Wiley) in April 2010. Seventy-five hundred books were published and distributed to physicians and physician groups (through CAPP, AMA, AMGA, CAPG), hospital leadership (through AHA and AAMC), policy thought leaders, and attendees at a variety of ACO-related conferences and meetings throughout 2010. Additionally, Dr. Crosson and this publication were featured in Accountable Care News, CAPG Health, and Modern Healthcare.
Delivery System Reform Tracking
This is a joint project of CAPP, The Commonwealth Fund, Kaiser Permanente Institute for Health Policy, and Alain Enthoven, PhD, of Stanford to develop a mechanism to understand and measure the evolution of delivery system reform across the nation. A roundtable meeting was held in March, 2010; following that, a meeting summary and key discussion points were distributed. A draft paper for publication has been developed that makes the case for the need of such a tracking effort and proposes elements that should be included and that can be measured, such as structure, capabilities, incentives, and outcomes.
STATUS: The paper will be published by The Commonwealth Fund early in 2011.
Physician Leadership Project
The objective of this project is to guide delivery system reform efforts that strive for quality and cost improvements by influencing physician leadership throughout the American health care system, leveraging CAPP groups’ knowledge and history, and promoting CAPP group perspectives around leadership and delivery system reform in a world of accountability.
STATUS: The project has been funded and launched.
Accountable Care Organizations as Part of Delivery System Reform
Much of delivery system reform thinking is focused currently on the "ACO" concept, which continues to evolve and be defined. Several issues need to be addressed to ensure the success of the ACO concept, including deciding the best payment and attribution models, ACO organizational capabilities and legal safeguards. To promote good public policy and to avoid the failure of ACOs, CAPP believes that existing group practice-based delivery systems should be involved in helping to address these issues. Through a targeted set of interviews with health policy leaders, CAPP will identify priorities and follow-up activities, potentially including production of a multi-author perspective piece that will provide ideas to CMS (and the Innovation Center in particular) about how to spur innovation and clinical transformation, and what structural and payment models should be tested.
STATUS: Interviews are being conducted.
The goal for the Communications Workgroup in 2010 was to increase our understanding of how to communicate the benefits of the multi-specialty group and organized delivery system to all stakeholders within the context of federal efforts towards health care reform.
Accountable Care Public Education and Advocacy Strategy
Using the results of the 2009 focus groups, the Communications workgroup developed a strategy designed to establish a vision of quality coordinated care, build on opportunities to define accountable care in reform debates, and position our organizations as best suited to provide it. The workgroup agreed on a social marketing Internet campaign built around "AccountableCareChoices.org." The campaign involves three micro sites—one targeted to consumers, one to media, and one to policymakers—with content tailored for each audience. The consumer site provides a vision of coordinated, accountable care, FAQs about the benefits of care coordination and ACOs, tools with which to assess quality care, and case studies and patient testimonials, as well as an action center through which consumers can weigh in on care coordination. The media micro site, while similar in its purpose and some content, provides more case studies, facts and statistics, clear definitions of care coordination, ACOs, etc., and the ability to find experts in their media markets to contact for commentary on delivery system reform. The policymaker site likewise strives to educate policymakers on delivery system attributes that foster care coordination and accountability, provides patient testimonials on the need and benefits, and features a research packet that legislative staffers can download for a quick tutorial on care coordination and ACOs.
STATUS: This campaign was approved by the CAPP leadership, has been funded by CAPP medical groups, the American Medical Group Association, California Association of Physician Groups, and the Alliance of Community Health Plans, and is scheduled to launch in early second quarter 2010.