Do Health Care Delivery System Reforms Improve Value? the Jury Is Still Out

Medical Care

Volumn 54, Issue 1, 2016, Pages 55-66

  Korenstein, Deborah ^a   Duan, Kevin ^b   Diaz, Manuel J ^b   Ahn, Rosa ^c   Keyhani, Salomeh ^c,d  

^a MEMORIAL SLOAN KETTERING CANCER CENTER   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c VETERANS AFFAIRS MEDICAL CENTER   (United States)

^d UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Care delivery system; cost containment; quality of care

Indexed keywords

ARTICLE; COST CONTROL; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HEALTH CARE UTILIZATION; HUMAN; MEDLINE; OUTCOME ASSESSMENT; PRIORITY JOURNAL; PROSPECTIVE STUDY; QUALITY CONTROL; RETROSPECTIVE STUDY; SYSTEMATIC REVIEW; UNITED STATES; EVIDENCE BASED MEDICINE; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH MAINTENANCE ORGANIZATION; ORGANIZATION AND MANAGEMENT; PATIENT CARE; PRIMARY HEALTH CARE; TOTAL QUALITY MANAGEMENT;

EVIDENCE-BASED MEDICINE; HEALTH CARE REFORM; HEALTH MAINTENANCE ORGANIZATIONS; HEALTH PLAN IMPLEMENTATION; HUMANS; PATIENT-CENTERED CARE; PRIMARY HEALTH CARE; QUALITY IMPROVEMENT; UNITED STATES;

EID: 84952874905     PISSN: 00257079     EISSN: 15371948     Source Type: Journal    
DOI: 10.1097/MLR.0000000000000445     Document Type: Article

References (45)

1. Porter M. A strategy for health care reform-toward a value-based system. N Engl J Med. 2009;361:109-112.
2. Porter M. What is value in health care? N Engl J Med. 2010;363: 2477-2481.
3. VanLare JM, Conway P. Value-based purchasing-national programs to move from volume to value. New Engl J Med. 2012;367:292-295.
4. Lewin J, Atkins G, McNeely L. The elusive path to health care sustainability. JAMA. 2013;310:1669-1670.
5. Marmor T, Oberlander J. From HMOs to ACOs: the quest for the Holy Grail in US health policy. J Gen Intern Med. 2012;27:1215-1218.
6. Two blues Plans Find Success With Medical Homes, Look to Expansion. Health Business Daily. 2011. Available at: http://aishealth. com/archive/nblu1111-03. Accessed February 4, 2015.
7. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. BMJ. 2009;62: e1-e34.
8. Shiroiwa T, Sung YK, Fukuda T, et al. International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost-effectiveness? Health Econ. 2010;19:422-437.
9. Rosenthal MB, Friedberg MW, Singer SJ, et al. Effect of a multipayer patient-centered medical home on health care utilization and quality: the Rhode Island chronic care sustainability initiative pilot program. JAMA Intern Med. 2013;173:1907-1913.
10. Higgins J, Altman D, Gotzsche P, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
11. The Cochrane Collaboration. Tool to Assess Risk of Bias in Cohort Studies. Available at: https://bmg.cochrane.org/sites/bmg.cochrane.org/files/uploads/Tool%20to%20Assess%20Risk%20of%20Bias%20in%20 Cohort%20Studies.pdf. Accessed February 4, 2015.
12. Kaushal R, Edwards A, Kern LM. Association between patient-centered medical home and healthcare utilization. Am J Man Care. 2015;21: 378-386.
13. van Hasselt M, McCall N, Keyes V, et al. Total cost of care lower among Medicare fee-for-service beneficiaries receiving care from patient-centered medical homes. Health Serv Res. 2015;50:253-272.
14. Friedberg MW, Schneider EC, Rosenthal MB, et al. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA. 2014;311: 815-825.
15. Christensen EW, Dorrance KA, Ramchandani S, et al. Impact of a patient-centered medical home on access, quality, and cost. Mil Med. 2013;178:135-141.
16. Hochman ME, Asch S, Jibilian A, et al. Patient-centered medical home intervention at an internal medicine resident safety-net clinic. JAMA Intern Med. 2013;173:1694-1701.
17. Liss DT, Fishman PA, Rutter CM, et al. Outcomes among chronically ill adults in a medical home prototype. Am J Manag Care. 2013;19:E348-E358.
18. Werner RM, Duggan M, Duey K, et al. The patient-centered medical home: an evaluation of a single private payer demonstration in New Jersey. Med Care. 2013;51:487-493.
19. DeVries A, Li CH, Sridhar G, et al. Impact of medical homes on quality, healthcare utilization, and costs. Am J Manag Care. 2012;18:534-544.
20. Fishman PA, Johnson EA, Coleman K, et al. Impact on seniors of the patient-centered medical home: evidence from a pilot study. Gerontol-ogist. 2012;52:703-711.
21. Raskas RS, Latts LM, Hummel JR, et al. Early results show WellPoint's patient-centered medical home pilots have met some goals for costs, utilization, and quality. Health Aff (Millwood). 2012;31:2002-2009.
22. Rosenberg CN, Peele P, Keyser D, et al. Results from a patient-centered medical home pilot at UPMC Health Plan hold lessons for broader adoption of the model. Health Aff (Millwood). 2012;31:2423-2431.
23. Reid RJ, Coleman K, Johnson EA, et al. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29:835-843.
24. Lemak CH, Nahra TA, Cohen GR, et al. Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care. Health Aff (Millwood). 2015;34:645-652.
25. McWilliams JM, Chernew ME, Landon BE, et al. Performance differences in year 1 of pioneer accountable organizations. N Engl J Med. 2015;372:1927-1936.
26. Chien AT, Song Z, Chernew ME, et al. Two-year impact of the alternative quality contract on pediatric health care quality and spending. Pediatrics. 2014;133:96-104.
27. Esse T, Serna O, Chitnis A, et al. Quality compensation programs: are they worth all the hype? A comparison of outcomes within a Medicare advantage heart failure population. J Manag Care Pharm. 2013;19:317-324.
28. Calikoglu S, Murray R, Feeney D. Hospital pay-for-performance programs in Maryland produced strong results, including reduced hospital-acquired conditions. Health Aff (Millwood). 2012;31:2649-2658.
29. Colla CH, Wennberg DE, Meara E, et al. Spending differences associated with the Medicare Physician Group Practice Demonstration. JAMA. 2012;308:1015-1023.
30. Song Z, Safran DG, Landon BE, et al. The 'Alternative Quality Contract, ' based on a global budget, lowered medical spending and improved quality. Health Aff (Millwood). 2012;31:1885-1894.
31. Chen JY, Tian H, Taira Juarez D, et al. The effect of a PPO pay-for-performance program on patients with diabetes. Am J Man Care. 2010; 16:e11-e19.
32. Leitman IM, Levin R, Lipp MJ, et al. Quality and financial outcomes from gainsharing for inpatient admissions: a three-year experience. J Hosp Med. 2010;5:501-507.
33. Ryan AM. Effects of the Premier Hospital Quality Incentive Demonstration on Medicare patient mortality and cost. Health Serv Res. 2009;44:821-842.
34. Friedberg MW, Rosenthal MB, Werner RM, et al. Effects of a medical home and shared savings intervention on quality and utilization of care. JAMA Intern Med. 2015;175:1362-1368.
35. Fifield J, Forrest DD, Burleson JA, et al. Quality and efficiency in small practices transitioning to patient centered medical homes: a randomized trial. J Gen Intern Med. 2013;28:778-786.
36. Claffey TF, Agostini JV, Collet EN, et al. Payer-provider collaboration in accountable care reduced use and improved quality in Maine Medicare Advantage plan. Health Aff (Millwood). 2012;31:2074-2083.
37. Salmon RB, Sanderson MI, Walters BA, et al. A collaborative accountable care model in three practices showed promising early results on costs and quality of care. Health Aff (Millwood). 2012; 31:2379-2387.
38. Fagan PJ, Schuster AB, Boyd C, et al. Chronic care improvement in primary care: evaluation of an integrated pay-for-performance and practice-based care coordination program among elderly patients with diabetes. Health Serv Res. 2010;45(6 pt 1):1763-1782.
39. Gilfillan RJ, Tomcavage J, Rosenthal MB, et al. Value and the medical home: effects of transformed primary care. Am J Man Care. 2010;16:607-614.
40. Mant J, Hicks N. Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarction. BMJ. 1995;311:793-796.
41. Glickman SW, Boulding W, Roos JM, et al. Alternative pay-for-performance scoring methods: implications for quality improvement and patient outcomes. Med Care. 2009;47:1062-1068.
42. Fleetcroft R, Steel N, Cookson R, et al. Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis. BMC Health Serv Res. 2012;12:94.
43. James TI. Is it time to change directions of quality measures? Am J Med Qual. 2014;29:555-556.
44. Korenstein D, Falk R, Howell E, et al. Overuse of health care services in the United States: an understudied problem. JAMA Intern Med. 2012;172:171-178.
45. Painter M, Chernew ME. Counting Change. Princeton, NJ: Robert Wood Johnson Foundation; 2012. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2012/03/counting-change.html. Accessed November 26, 2014.