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.
University of Michigan Group Practice Performance Study
In 2006, CAPP launched a study to analyze data from CAPP multispecialty group practices and Medicare fee-for-service claims from Dartmouth’s database to look at organizational attributes and care management processes at these organizations. The study, published in May, 2010 in Health Affairs, provided further evidence that large multispecialty groups and organized delivery systems deliver higher quality care at a lower cost than other providers in their market regions.
In a follow-up study that would replicate this methodology, researchers at the University of Michigan and Dartmouth are now analyzing common inpatient medical and surgical conditions around quality (risk-adjusted mortality, postoperative complications and failure to rescue, hospital readmissions) and efficiency (overall hospital payments; payments for readmissions, physician services, post-discharge ancillary care; payments for specific high-cost populations)
STATUS: The study is in process.
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 physician groups 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 delivery systems and medical groups and identify key issues they must address to advance their state of preparation.
STATUS: The survey was sent into the field in May, 2011.
These projects were designed to support policy positions or further the knowledge base about how multi-specialty medical groups provide care.
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: Paper was published by The Commonwealth Fund in June, 2011.
Physician Leadership Project
Delivery system reform efforts that strive for quality and cost improvements require physician leadership throughout the American health care system. The goal of this project is to interview recognized physician leaders of organized delivery systems about the relative importance of certain organizational attributes, governance, skill sets, and practices that effectively develop physician leaders to serve their organizations, and the relative difficulty in implementing, developing, or training each based on the experience of these groups.
STATUS: Interviews are being conducted.
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. From the findings of a targeted set of interviews with health policy leaders, CAPP will develop recommendations for policy and regulatory changes to enhance likelihood of ACO success in the long run in the following areas:
•Attribution/assignment - Explore various ideas/models for prospective attribution.
•Payment/incentives – Explore public and private payment models to ACOs that strike the right balance between encouraging broad participation and achieving payment reductions/cost savings
•Hospitals – Explore successful models of collaborations/partnerships between physicians and hospitals
STATUS: Project plans for these three areas of study are in development.
Communications projects are designed to increase our understanding of how to communicate the benefits of the organized delivery systems 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 health care reform debates, and position our organizations as best suited to provide it. The workgroup agreed on a social marketing Internet campaign built around “www.5RealAnswers.org.” The campaign involves three micro sites—one targeted to consumers, one to media, and one to policymakers—with content tailored for each audience.
STATUS: The micro sites (www.accountablecarechoices.org, www.accountablecarestories.org, www.accountablecarefacts.org) were launched on April 5, 2011. Stories about the project have been published in CAPG Health, The Group Practice Journal and ACOInsights.