Jennifer E. Layden, Matthew J. Swain, Niall Brennan, Micky Tripathi
PUBLIC HEALTH AND CARE DELIVERY THEME ISSUE: The collective health of the United States can be significantly improved and protected by better communication and sharing of data between health care providers and public health systems. The authors discuss initiatives designed to standardize the exchange of information, break down long-standing siloes, update antiquated systems, and liberate data for maximum utility and impact.
{"title":"Plugging Public Health Data into the Health IT Ecosystem to Protect National Health","authors":"Jennifer E. Layden, Matthew J. Swain, Niall Brennan, Micky Tripathi","doi":"10.1056/CAT.24.0129","DOIUrl":"https://doi.org/10.1056/CAT.24.0129","url":null,"abstract":"PUBLIC HEALTH AND CARE DELIVERY THEME ISSUE: The collective health of the United States can be significantly improved and protected by better communication and sharing of data between health care providers and public health systems. The authors discuss initiatives designed to standardize the exchange of information, break down long-standing siloes, update antiquated systems, and liberate data for maximum utility and impact.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141828807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ingrid Johansen, Mohammed Selim, Mark Jackson, Carolina Ramirez Rattray
PUBLIC HEALTH AND CARE DELIVERY THEME ISSUE: Through partnerships with trusted community-based organizations, health systems and public health are able to expand access to care for the vulnerable segments of the population. The experience of Saint Paul – Ramsey County Public Health, Fairview Health Services, and many local community and faith-based partners has implications for ongoing teamwork in care delivery.
{"title":"Knocking Down Public Health and Health Care Silos: An Innovative Covid-19 Health Equity Response","authors":"Ingrid Johansen, Mohammed Selim, Mark Jackson, Carolina Ramirez Rattray","doi":"10.1056/CAT.24.0118","DOIUrl":"https://doi.org/10.1056/CAT.24.0118","url":null,"abstract":"PUBLIC HEALTH AND CARE DELIVERY THEME ISSUE: Through partnerships with trusted community-based organizations, health systems and public health are able to expand access to care for the vulnerable segments of the population. The experience of Saint Paul – Ramsey County Public Health, Fairview Health Services, and many local community and faith-based partners has implications for ongoing teamwork in care delivery.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":" 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141829636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Judith E. Klein, Benedict J. Carey, Elyn R. Saks, P. Murali Doraiswamy
SummaryThe nonprofit organization INclude – the Mental Health Initiative has developed and deployed an independent, data-backed navigation service in North Carolina and provides insights and lessons learned from its first year of operation as a pilot. The Mental Health GPS model starts with the traditional peer-run warmline for people who may just want to talk or learn about available, suited resources. It then enhances this basic support with sophisticated human and database resources to provide an independent navigation service delivered by peer support specialists who possess both relevant life experience and clinical knowledge/fluency, and are backed by a vetted list of mental health providers to ensure guidance to apt services. The GPS is not designed to be a crisis hotline for imminent life-and-death circumstances, but instead to help a person navigate the mental health system and effectively avert a crisis. In the 1-year pilot, the Mental Health GPS service received 2,384 calls or texts, almost all generated by Internet searches on smartphones. The themes most often associated with caller concerns were work/personal (41.6%), depression (11.7%), and general anxiety (7.2%).
非营利组织INclude - the Mental Health Initiative在北卡罗来纳州开发并部署了一项独立的、有数据支持的导航服务，并提供了第一年作为试点运营的见解和经验教训。心理健康GPS模式从传统的同行热线开始，为那些可能只是想谈谈或了解可用的、合适的资源的人提供服务。然后，它利用先进的人力资源和数据库资源加强这一基本支持，提供由拥有相关生活经验和临床知识/流利程度的同伴支持专家提供的独立导航服务，并由经过审查的心理健康提供者名单提供支持，以确保对适当服务的指导。全球定位系统的设计并不是为了在生死攸关的情况下成为危机热线，而是为了帮助人们在心理健康系统中导航，有效地避免危机。在为期一年的试点中，心理健康GPS服务收到了2384个电话或短信，几乎都是通过智能手机上的互联网搜索产生的。与打电话者最常关注的主题是工作/个人(41.6%)、抑郁(11.7%)和一般焦虑(7.2%)。
{"title":"Independent Care Navigators for the Mental Health Maze","authors":"Judith E. Klein, Benedict J. Carey, Elyn R. Saks, P. Murali Doraiswamy","doi":"10.1056/cat.23.0231","DOIUrl":"https://doi.org/10.1056/cat.23.0231","url":null,"abstract":"SummaryThe nonprofit organization INclude – the Mental Health Initiative has developed and deployed an independent, data-backed navigation service in North Carolina and provides insights and lessons learned from its first year of operation as a pilot. The Mental Health GPS model starts with the traditional peer-run warmline for people who may just want to talk or learn about available, suited resources. It then enhances this basic support with sophisticated human and database resources to provide an independent navigation service delivered by peer support specialists who possess both relevant life experience and clinical knowledge/fluency, and are backed by a vetted list of mental health providers to ensure guidance to apt services. The GPS is not designed to be a crisis hotline for imminent life-and-death circumstances, but instead to help a person navigate the mental health system and effectively avert a crisis. In the 1-year pilot, the Mental Health GPS service received 2,384 calls or texts, almost all generated by Internet searches on smartphones. The themes most often associated with caller concerns were work/personal (41.6%), depression (11.7%), and general anxiety (7.2%).","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"875 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135885233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David W. Bates, Jens Deerberg-Wittram, Gregory Katz, Katharina Braeger, Lena S. Hirsch, Gary S. Kaplan, Lukas Kwietniewski, Christoph A. Meier, Camila Plaza de Laifer, Eyal Zimlichman
SummaryPatient-reported outcome measures (PROMs) represent an essential element of value-based care in health care sectors worldwide by transferring the quality definition from process- to outcome-based indicators that focus on the patients’ needs. However, the adoption rate of PROMs in hospitals is still low. To address this challenge and to account for the growing importance of value-based health care, Newsweek and Statista developed a PROMs implementation survey along with a global board of medical experts to determine the current state of PROMs implementation in hospitals. The results of this survey were incorporated into the 2023 editions of Newsweek’s World’s Best Specialized Hospitals and World’s Best Hospitals rankings. The inclusion of PROMs adds a patient outcome–focused dimension that overcomes methodologic limitations and improves the comprehensiveness of these rankings. Furthermore, the public reporting of clinical outcomes such as PROMs serves as a catalyst to improve the quality of care. In this article, the authors describe what they believe is the increasing relevance of value-based health care and PROMs, the process of developing and launching the PROMs implementation survey, and its incorporation into hospital rankings to improve the value of care for patients on a global level.
{"title":"Using Publicly Reported Global Hospital Rankings to Improve Dissemination of Patient-Reported Outcome Measures (PROMs)","authors":"David W. Bates, Jens Deerberg-Wittram, Gregory Katz, Katharina Braeger, Lena S. Hirsch, Gary S. Kaplan, Lukas Kwietniewski, Christoph A. Meier, Camila Plaza de Laifer, Eyal Zimlichman","doi":"10.1056/cat.23.0097","DOIUrl":"https://doi.org/10.1056/cat.23.0097","url":null,"abstract":"SummaryPatient-reported outcome measures (PROMs) represent an essential element of value-based care in health care sectors worldwide by transferring the quality definition from process- to outcome-based indicators that focus on the patients’ needs. However, the adoption rate of PROMs in hospitals is still low. To address this challenge and to account for the growing importance of value-based health care, Newsweek and Statista developed a PROMs implementation survey along with a global board of medical experts to determine the current state of PROMs implementation in hospitals. The results of this survey were incorporated into the 2023 editions of Newsweek’s World’s Best Specialized Hospitals and World’s Best Hospitals rankings. The inclusion of PROMs adds a patient outcome–focused dimension that overcomes methodologic limitations and improves the comprehensiveness of these rankings. Furthermore, the public reporting of clinical outcomes such as PROMs serves as a catalyst to improve the quality of care. In this article, the authors describe what they believe is the increasing relevance of value-based health care and PROMs, the process of developing and launching the PROMs implementation survey, and its incorporation into hospital rankings to improve the value of care for patients on a global level.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edward Prewitt, Namita Seth Mohta, Lisa Gordon, Thomas H. Lee
SummaryThis issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on U.S. Centers for Medicare & Medicaid payment models, mental health navigation, patient transfers, machine learning, HIV preexposure prophylaxis, patient-reported outcome measures and hospital rankings, and post-acute care.
本期NEJM Catalyst Innovations in Care Delivery包括文章、案例研究和研究报告，内容涉及美国医疗保险和医疗补助中心的支付模式、心理健康导航、患者转移、机器学习、HIV暴露前预防、患者报告的结果测量和医院排名，以及急性后护理。
{"title":"Improving the Value of Health Care and Accelerating Care Delivery Transformation","authors":"Edward Prewitt, Namita Seth Mohta, Lisa Gordon, Thomas H. Lee","doi":"10.1056/cat.23.0320","DOIUrl":"https://doi.org/10.1056/cat.23.0320","url":null,"abstract":"SummaryThis issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on U.S. Centers for Medicare & Medicaid payment models, mental health navigation, patient transfers, machine learning, HIV preexposure prophylaxis, patient-reported outcome measures and hospital rankings, and post-acute care.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135823595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SummaryA survey of the NEJM Catalyst Insights Council finds many challenges to post-acute care. A new payment model is needed for long-term success.
NEJM催化剂洞察委员会的一项调查发现，急性后护理面临许多挑战。长期成功需要一种新的付费模式。
{"title":"Post-Acute Care Struggles with Staffing Shortages","authors":"Thomas Schaaf","doi":"10.1056/cat.23.0318","DOIUrl":"https://doi.org/10.1056/cat.23.0318","url":null,"abstract":"SummaryA survey of the NEJM Catalyst Insights Council finds many challenges to post-acute care. A new payment model is needed for long-term success.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135883854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Douglas S. Krakower, Michael Lieberman, Miguel Marino, Jun Hwang, Kenneth H. Mayer, Julia L. Marcus
SummaryAntiretroviral preexposure prophylaxis (PrEP) is nearly 100% effective at decreasing HIV acquisition but is underused in priority populations. Primary care clinicians need tools to help them identify persons likely to benefit from PrEP use and prescribe it when appropriate. The researchers developed and validated an automated decision support tool with interactive alerts in the electronic health record to increase PrEP discussions and prescribing in primary care. They piloted the tool at three federally qualified health centers and assessed feasibility, acceptance by clinicians, and preliminary impact on PrEP care. Of 33,803 patients who visited the pilot clinics from July 2022 through January 2023, providers received PrEP alerts at the point of care for 2.2% of patients, demonstrating feasibility. Although numbers of PrEP prescriptions remained low, the proportion of all patients with new PrEP prescriptions was 4.5 times higher at pilot clinics compared with matched control clinics (0.09% vs. 0.02%). Implementation of the decision support tool was associated with a statistically nonsignificant 5.5% increase in HIV tests per 100 patients. In qualitative interviews, providers said the tool facilitated PrEP discussions with patients, particularly for those patients who would not have initiated discussions because of stigma. The researchers found that acceptance, use, and impact of machine-learning models for PrEP depends on collaborating with and building trust among providers, including blending a data-driven approach to identifying patients at increased risk for HIV acquisition with providers’ traditional decision-making framework. These approaches could be useful for health care organizations seeking to implement automated prediction models across all areas of medicine.
{"title":"Implementing an Automated Prediction Model to Improve Prescribing of HIV Preexposure Prophylaxis","authors":"Douglas S. Krakower, Michael Lieberman, Miguel Marino, Jun Hwang, Kenneth H. Mayer, Julia L. Marcus","doi":"10.1056/cat.23.0215","DOIUrl":"https://doi.org/10.1056/cat.23.0215","url":null,"abstract":"SummaryAntiretroviral preexposure prophylaxis (PrEP) is nearly 100% effective at decreasing HIV acquisition but is underused in priority populations. Primary care clinicians need tools to help them identify persons likely to benefit from PrEP use and prescribe it when appropriate. The researchers developed and validated an automated decision support tool with interactive alerts in the electronic health record to increase PrEP discussions and prescribing in primary care. They piloted the tool at three federally qualified health centers and assessed feasibility, acceptance by clinicians, and preliminary impact on PrEP care. Of 33,803 patients who visited the pilot clinics from July 2022 through January 2023, providers received PrEP alerts at the point of care for 2.2% of patients, demonstrating feasibility. Although numbers of PrEP prescriptions remained low, the proportion of all patients with new PrEP prescriptions was 4.5 times higher at pilot clinics compared with matched control clinics (0.09% vs. 0.02%). Implementation of the decision support tool was associated with a statistically nonsignificant 5.5% increase in HIV tests per 100 patients. In qualitative interviews, providers said the tool facilitated PrEP discussions with patients, particularly for those patients who would not have initiated discussions because of stigma. The researchers found that acceptance, use, and impact of machine-learning models for PrEP depends on collaborating with and building trust among providers, including blending a data-driven approach to identifying patients at increased risk for HIV acquisition with providers’ traditional decision-making framework. These approaches could be useful for health care organizations seeking to implement automated prediction models across all areas of medicine.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135883595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SummaryInterviews from NEJM Catalyst Insights Council members on the staffing shortages, increased patient acuity, and other problems facing post-acute care.
{"title":"Post-Acute Care Faces a Perfect Storm of Challenges","authors":"Jonathan Bees","doi":"10.1056/cat.23.0321","DOIUrl":"https://doi.org/10.1056/cat.23.0321","url":null,"abstract":"SummaryInterviews from NEJM Catalyst Insights Council members on the staffing shortages, increased patient acuity, and other problems facing post-acute care.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Jesse Hendricks, Alexandra Wiggins, Stephanie A. C. Halvorson, Matthias Johannes Merkel
SummaryThe interhospital transfer process is complex and susceptible to logistic errors, inefficiencies, and patient harm. Historically, hospitalists at Oregon Health & Science University (OHSU) were responsible for managing incoming Medicine transfer requests in addition to concurrent clinical and teaching duties. Transfer patients sometimes arrived unprepared for planned interventions, lacking necessary records, or clinically unstable. Others were transferred without a clear need for a higher level of care. In response, OHSU created the Intake Hospitalist role — a dedicated and specially trained hospitalist without other clinical and educational duties, who manages all direct admissions, intrahospital transfers of service, and interhospital transfer requests to the Medicine service. The goal of the Intake Hospitalist program is to improve the quality and safety of the transfer process and accept the “right patient, at the right time, to the right place.” The role was implemented in January 2021 and has led to appreciable improvements in patient safety, standardization, bed utilization, and physician experience. Notably, the authors found the cost of this program has been offset by the indirect financial savings created through backfill of inpatient beds with higher-complexity patients. The Intake Hospitalist has proven so successful that OHSU developed similar roles for the ICUs and Pediatrics during high-demand situations. The authors believe this model could be successful at other large academic centers.
{"title":"Intake Hospitalist: A New Role to Maximize the Safety and Efficiency of Interhospital Transfers","authors":"Michael Jesse Hendricks, Alexandra Wiggins, Stephanie A. C. Halvorson, Matthias Johannes Merkel","doi":"10.1056/cat.23.0198","DOIUrl":"https://doi.org/10.1056/cat.23.0198","url":null,"abstract":"SummaryThe interhospital transfer process is complex and susceptible to logistic errors, inefficiencies, and patient harm. Historically, hospitalists at Oregon Health & Science University (OHSU) were responsible for managing incoming Medicine transfer requests in addition to concurrent clinical and teaching duties. Transfer patients sometimes arrived unprepared for planned interventions, lacking necessary records, or clinically unstable. Others were transferred without a clear need for a higher level of care. In response, OHSU created the Intake Hospitalist role — a dedicated and specially trained hospitalist without other clinical and educational duties, who manages all direct admissions, intrahospital transfers of service, and interhospital transfer requests to the Medicine service. The goal of the Intake Hospitalist program is to improve the quality and safety of the transfer process and accept the “right patient, at the right time, to the right place.” The role was implemented in January 2021 and has led to appreciable improvements in patient safety, standardization, bed utilization, and physician experience. Notably, the authors found the cost of this program has been offset by the indirect financial savings created through backfill of inpatient beds with higher-complexity patients. The Intake Hospitalist has proven so successful that OHSU developed similar roles for the ICUs and Pediatrics during high-demand situations. The authors believe this model could be successful at other large academic centers.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135824389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth Fowler, Noemi Rudolph, Kate Davidson, Bruce Finke, Shannon Flood, Susannah M. Bernheim, Purva Rawal
SummaryOver the past decade, the U.S. Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMS Innovation Center) has tested more than 50 payment models with a range of participants and value-based payment features. Value-based payment models can provide the necessary flexibility to support care delivery that better addresses people’s health and health-related social needs. This transformation of the delivery system, supported by value-based payment models, can drive better care, improve outcomes, and lower costs. The impact of CMS Innovation Center models has largely focused on financial impacts, with varied results in terms of total health care cost reduction. There has been less focus on the extent to which payment models have enabled care delivery transformation. To inform the development of a new framework to better assess the impacts of payment models and to drive care delivery transformation, the CMS Innovation Center undertook a retrospective review and synthesis of select models to assess if — and which — care delivery changes have been observed. The review indicated demonstrable evidence of enhanced care delivery in several areas, such as care coordination, team-based care, and leveraging data to risk-stratify patients, among other strategies. Three broad themes are shared among the more successful efforts. (1) Participants across models used common care coordination and other strategies to deliver person-centered care, (2) practice changes enabled by value-based care models showed evidence of tailoring care to local needs, and (3) care delivery trends and changes extend beyond the CMS Innovation Center models. This article summarizes those findings, which are informing the development of a new framework to accelerate care transformation.
{"title":"Accelerating Care Delivery Transformation — The CMS Innovation Center’s Role in the Next Decade","authors":"Elizabeth Fowler, Noemi Rudolph, Kate Davidson, Bruce Finke, Shannon Flood, Susannah M. Bernheim, Purva Rawal","doi":"10.1056/cat.23.0228","DOIUrl":"https://doi.org/10.1056/cat.23.0228","url":null,"abstract":"SummaryOver the past decade, the U.S. Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMS Innovation Center) has tested more than 50 payment models with a range of participants and value-based payment features. Value-based payment models can provide the necessary flexibility to support care delivery that better addresses people’s health and health-related social needs. This transformation of the delivery system, supported by value-based payment models, can drive better care, improve outcomes, and lower costs. The impact of CMS Innovation Center models has largely focused on financial impacts, with varied results in terms of total health care cost reduction. There has been less focus on the extent to which payment models have enabled care delivery transformation. To inform the development of a new framework to better assess the impacts of payment models and to drive care delivery transformation, the CMS Innovation Center undertook a retrospective review and synthesis of select models to assess if — and which — care delivery changes have been observed. The review indicated demonstrable evidence of enhanced care delivery in several areas, such as care coordination, team-based care, and leveraging data to risk-stratify patients, among other strategies. Three broad themes are shared among the more successful efforts. (1) Participants across models used common care coordination and other strategies to deliver person-centered care, (2) practice changes enabled by value-based care models showed evidence of tailoring care to local needs, and (3) care delivery trends and changes extend beyond the CMS Innovation Center models. This article summarizes those findings, which are informing the development of a new framework to accelerate care transformation.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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