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 multi-specialty 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 health care delivery systems deliver higher quality care at a lower cost than other providers in their market regions.
Recently, the researchers at the University of Michigan and Dartmouth approached CAPP regarding a follow-up study that would replicate the methodology, but use data to analyze 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: Updated data-use agreements are being collected to conduct analyses with UPIN and claims data from the previous study.
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 learnings 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: Final research activities and data analyses are being conducted. A blinded benchmark report from the initial survey data was sent to respondents. A paper based on the findings is being drafted and plans for a possible convening around the findings in the fall of 2012 are under consideration.
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 paper that explains the need for such a tracking effort, and proposes measurable elements that should be included in such an effort (e.g., structure, capabilities, incentives, and outcomes) was published in June.
STATUS: The final paper published by the Commonwealth Fund as an issue brief in June 2011.
ACOs as Part of Delivery System Reform
Currently, many delivery system reform activities are focused on the “ACO” concept, which continues to evolve and be defined. Many design and implementation issues need to be addressed to ensure the ultimate success of the ACO concept, including payment incentives, ACO organizational and governance models 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 activities, CAPP will seek to influence policy makers, regulators, health care industry leaders and perhaps the public and the media so that the development of the ACO concept proceeds in a direction that is both operationally feasible and promotes sound public policy. The following four project areas are being explored:
Physician Leadership—Delivery system reform efforts that strive for quality and cost improvements require physician leadership. The goal of this project is to poll 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. CAPP is exploring using the results of this study to develop a how-to “handbook” to assist organizations in moving from limited physician leadership to robust programs. Other possible uses for project findings under consideration include convening a one-day event to disseminate results, development of a teaching module based on key ideas and recommendations and publication in a peer-reviewed journal.
STATUS: Interviews have been conducted with 15 physician group leaders, most of whom represent CAPP groups, and seven leadership development directors of those groups. A preliminary report has been developed and several methods of disseminating the results are under consideration.
Physician Hospital Integration- This study is focused on two key questions:
1.) How are hospitals navigating the potential long-term revenue reductions resulting from the implementation of value-based purchasing and the movement towards population based payment/accountable care models?
2.) What are the joint governance and management models that hospitals and physicians are developing in nascent accountable care organizations? What are the key challenges in this process? How do organizations that have undergone a transformation view their efforts and why?
CAPP is considering conducting a series of case studies on organizations that are undergoing transformation of their payment, governance and revenue models. The main deliverables may include a paper published in a peer-reviewed journal and a public meeting on the topic. Other deliverables may be identified at a later date based on research findings.
STATUS: Initial research activities and information gathering has begun. Case study development will continue into late 2012.
Payment/Incentives- Proper payment mechanisms and incentives are another fundamental component of successful integrated delivery systems. The main objective of this project is to explore public and private payment models for ACOs that strike the appropriate balance between encouraging broad participation in accountable care models while achieving payment reductions and cost savings. The goal of this project is to build off of the work of the Brandies study to document the transition away from volume based revenue models. The main deliverables will include a paper or several papers published in a peer-reviewed journal and series of policy meetings that will provide a forum for discussion of the findings. Other deliverables may be identified at a later date based on research findings.
STATUS: A significant portion of this work is currently underway in the Brandeis/Commonwealth Fund Capitation and Salary study discussed above. We are actively engaged in developing partnership opportunities with the payment subgroup of the Brookings Institution ACO Learning Network. Through this potential partnership, the current Brandeis survey work could be expanded to more non-CAPP organizations. We are also considering launching another phase of survey work that is focused on organizational transformation towards new, non-volume based payment models.
These 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 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.
STATUS: The micro sites were launched on April 5, 2011. The sites are getting steady attention and engagement from the policy community, and CAPP has also started to receive media inquiries as a result of promotion and social marketing efforts (eblasts, searches, Twitter). Activity on the public site has increased, probably due to the announcement and communications about the Medicare Pioneer and Shared savings pilots to consumers. Enhancements to the site to address changes in the current ACO landscape across the country is in progress.
Transitioning to Accountable Care -- Implications for Healthcare Communicators:
In 2012, CAPP sought to better understand how medical groups and hospitals perceive the role of communications in ACO development and implementation. Sponsored by Maricich Healthcare and in partnership with the American Hospital Association, CAPP conducted an online survey with the members of the American Medical Group Association (representing physician groups) and of the Society of Healthcare Strategy & Market Development (representing hospital organizations) to answer these key questions: Do the organizations considering or implementing an accountable care initiative understand how important strategic communication is to their success? If so, do they have the communication resources to manage the change? Which stakeholder group do these organizations expect to be the most difficult to manage during the change? And, what will be the greatest barriers or concerns for that audience?
The survey was completed during July and August of 2012. Three reports were produced: one for AMGA specifically, one for SHSMD, and a CAPP report that combined the survey results from both groups. The reports were distributed to the survey respondents in November 2012.
STATUS: The combined CAPP report was disseminated in December 2012 and is available at http://www.maricich.com/aco