When Health Care Transformation Fails

Last year was tough for the transformation of health care from volume to value. Two major medical home studies (Friedberg and Rosenthal) and two major readmission prevention studies (Goldman and Dhalla) had negative to underwhelming results. Thirteen of the original 32 Pioneer Accountable Care Organizations (ACOs) have dropped out of the program. Of the original 220 Medicare Shared Savings Program ACOs, only 53 held spending enough below their targets to receive performance payments. Given the significant investments these ACOs made in the infrastructure needed to manage risk, and that the top 12 ACOs were responsible for half of the savings, the vast majority of participating systems have clearly lost money in the program. Does this mean that health care transformation is impossible and that we are stuck with the status quo until the next big idea comes along? Are previous studies showing that medical homes work, that readmissions are preventable, and that integrated care management can improve quality while lowering costs just publication bias, never to be reproduced? The problem is not that lower cost, higher quality care is impossible. As someone who spent most of his career in the world of integrated health care systems before moving to an academic medical system, I know there are many organizations that have been producing Triple-Aim results for decades (such as Intermountain, Group Health, HealthPartners, and Geisinger) -- systems where there is good evidence that t...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Featured Health Professionals Hospitals Organization and Delivery Quality ACOs adaptive reserve Health Reform National Demonstration Project PCMH triple aim Source Type: blogs