Strengthening the Center for Medicare and Medicaid Innovation's Approach to Constructing Alternative Payment Models.

The Center for Medicare and Medicaid Innovation (CMMI) seeks to develop evidence-based alternative payment models (APM) to improve health care quality and reduce costs, but its performance in achieving these goals has been mixed. In October 2021, CMMI released its Innovation Strategy Refresh to highlight challenges faced by payment models and suggest new strategic approaches for the upcoming decade. While a welcome recast of organizational goals, the Refresh leaves space for how CMMI will address persistent issues.

Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.

The American Medical Association asked RAND Health to characterize the factors that affect physician professional satisfaction. RAND researchers sought to identify high-priority determinants of professional satisfaction by gathering data from 30 physician practices in six states, using a combination of surveys and semistructured interviews. This article presents the results of the subsequent analysis.

Gaps in residency training should be addressed to better prepare doctors for a twenty-first-century delivery system.

Many observers have been concerned about a mismatch between the knowledge, skills, and professional values of newly trained physicians and the requirements of current and future medical practice. We surveyed and interviewed Kaiser Permanente's clinical department chiefs for internal medicine, pediatrics, general surgery, and obstetrics/gynecology to ascertain their views of the perceived gaps in the readiness of newly trained physicians. Nearly half of those surveyed reported deficiencies among new physicians in managing routine conditions or performing simple procedures often encountered in office-based practice.

Analysis & commentary: The accountable care organization: whatever its growing pains, the concept is too vitally important to fail.

The success of health reform efforts will depend, in part, on creating new and better ways to organize, deliver, and pay for health care. Increasingly central to this idea is the accountable care organization model proposed for Medicare and a slightly different model for commercial health care. But these new health care delivery and payment models face considerable skepticism.

Delivery system reform tracking: a framework for understanding change.

The health care delivery system is changing rapidly, with providers forming patient-centered medical homes and exploring the creation of accountable care organizations. Enactment of the Affordable Care Act will likely accelerate these changes. Significant delivery system reforms will simultaneously affect the structures, capabilities, incentives, and outcomes of the delivery system.

Meaningful variation in performance: what does variation in quality tell us about improving quality?

Background: Variance reduction is sometimes considered as a goal of clinical quality improvement. Variance among physicians, hospitals, or health plans has been evaluated as the proportion of total variance (or intraclass correlation, ICC) in a quality measure; low ICCs have been interpreted to indicate low potential for quality improvement at that level. However, the absolute amount of variation, expressed in clinically meaningful units, is less frequently reported.

How can Medicare lead delivery system reform?

The current fee-for-service system of paying for health care emphasizes volume and complexity, and often discourages attempts to improve effectiveness and efficiency. This brief discusses several policies that could begin to move away from the adverse incentives embedded in the current system to incentives that encourage better care and better value. The authors believe that U.

Toward a 21st-century health care system: recommendations for health care reform.

The coverage, cost, and quality problems of the U.S. health care system are evident.

Medicare: the place to start delivery system reform.

The development of accountable care organizations (ACOs) is an appropriate goal for delivery system reform. The Medicare program can be instrumental in starting the necessary transformations in payment design, incentives, and delivery system structure. Payment reforms are critical; should come first; and may need to be substantial, cumulative in impact, and dramatic in design.

'Redefining health care': medical homes or archipelagos to navigate?

This paper provides an analysis of the structure of the health care delivery system, emphasizing physician group practices. The authors argue for comprehensive integrated delivery systems (IDSs). The jumping-off point for their analysis is the recently published Redefining Health Care: Creating Value-Based Competition on Results, by Michael Porter and Elizabeth Teisberg.

A proposal to cover the uninsured in California.

The lack of health coverage for millions of Californians is a major societal problem. In the absence of federal action, we propose a state-based approach that leverages existing systems to create near-universal coverage within two years. We describe several subsidized benefit options for low-income uninsured Californians, emphasizing preventive and primary care, and we propose catastrophic coverage, at a minimum, for higher-income uninsured Californians.