A New Vision for California’s Healthcare System: Integrated Care with Aligned Financial Incentives

Scheffler, Richard M.; Bowers, Liora G.; Fulton, Brent D.; Connors, Clare; Shortell, Stephen M.; Morrison, Ian

doi:10.5070/p2n019

Cited by 9 publications

(9 citation statements)

References 35 publications

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“…31 Each group perceived growth as important to gain increasing economies of scale to build health information technology and care management infrastructures necessary to succeed in value-based contracting and to spread the risk for the costs of care over larger numbers of patients. The groups are capital-poor compared with hospitals and corporate buyers of physician practices and must continually decide whether to remain independent or to sell.…”

Section: Future Of Primary Care Practice Groupsmentioning

confidence: 99%

Large Independent Primary Care Medical Groups

Casalino

Chen

Staub³

et al. 2016

The Annals of Family Medicine

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PURPOSEIn the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges. METHODSWe identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers-leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. RESULTSThe groups' physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale.CONCLUSIONS Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting.

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Section: Future Of Primary Care Practice Groupsmentioning

confidence: 99%

Large Independent Primary Care Medical Groups

Casalino

Chen

Staub³

et al. 2016

The Annals of Family Medicine

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“…The residual includes changes in the volume and mix of services, changes in the use of cost-increasing and cost-decreasing technology, and measurement error. The volume and mix of services are changing because of payment and delivery system reforms, leading to lower expenditures in some cases (e.g., Melnick et al 2014;Scheffler et al 2013;Markovich 2012). On the other hand, technology, on net, has historically been cost increasing, because of new treatments (Newhouse 1992).…”

Section: Methodsmentioning

confidence: 99%

“…Additional details can be found in the December 2014 Berkeley Forum report Drivers of Health Expenditure Growth in California: Forecasts and Progress on Delivery System Integration as well as Scheffler et al (2013).…”

Section: Methodsmentioning

confidence: 99%

“…The proliferation of ACOs in California, as well as other financial risk sharing between health plans and providers, has sometimes led to expenditure reductions through changes in utilization and service mix (e.g., Melnick et al 2014;Scheffler et al 2013;Markovich 2012). In a number of instances, the savings are realized through lower utilization and a less expensive service mix, such as the shift from inpatient care to outpatient visits, as well as the use of generic drugs over brand names.…”

Section: Innovations With the Potential To Reduce The Rate Of Health mentioning

confidence: 99%

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Forecasts and Drivers of Health Expenditure Growth in California

Fulton¹,

Scheffler²,

Keolanui³

et al. 2015

CJPP

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California's state government, employers, and households are concerned about the future affordability of healthcare. We use health expenditure data from the Centers for Medicare & Medicaid Services' Office of the Actuary to forecast California's health expenditures from 2013 to 2022 and identify factors driving expenditure increases. Real health expenditures per capita (2013$) are forecasted to increase from $8,398 to $11,421 (or 36 percent), resulting in health expenditures increasing from 14.5 percent to 16.0 percent of California's economy. Expenditure increases are mostly driven by gains in real income per capita (40-60 percent), followed by medical-specific inflation (23 percent), an aging population (14 percent), and insurance coverage gains (8 percent). The -4 percent to 16 percent residual is attributable to changes in the volume and mix of services and technology. Several innovations could potentially dampen these increases, such as shared-risk, value-based payment models, practice redesign initiatives, lower cost settings and healthcare professionals, many of which are found in accountable care organizations.

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“…The scope of change and the implementation challenges of the ACA were of particular significance in California. California has a very diverse population, with over double the national rates of Asian and Latino residents, greater income disparity and higher rates of uninsured than the national average (Scheffler et al 2013). The number of uninsured Californians is greater than the entire population of each of 39 states (Kaiser Family Foundation 2011).…”

Section: Motivations Underlying Participation In the Berkeley Forummentioning

confidence: 99%

The Berkeley Forum – A Roadmap for Improving Healthcare in California

Bowers¹,

Scheffler²,

Shortell³

et al. 2014

CJPP

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The ACA's passage was followed by great uncertainty about how the healthcare landscape would transform. During this tumultuous period, a unique group of California's private sector health systems, medical groups and health plans, alongside public sector leaders, came together to help shape a more effective healthcare system. The Berkeley Forum, facilitated by the School of Public Health at the University of California-Berkeley, provided an opportunity for healthcare leaders to engage with peers and stakeholders in an intimate, collaborative manner, and address what they viewed as the largest threat -uncontrolled healthcare spending, detached from quality and outcomes. The group issued a report, endorsed by each of the private sector participants, containing far-reaching recommendations. The report's central tenant is the "Forum Vision", a rapid shift towards paying providers using riskadjusted global budgets rather than fee-for-service, coupled with greater use of integrated systems that coordinate care across settings, providers and time. Implementation of the Forum Vision along with six other initiatives, such as increased physical activity and palliative care access, could reduce healthcare spending by $110 billion in the coming 10 years. Today, these high-level leaders continue to provide a unified voice to promote better health and higher-quality, affordable care for Californians.

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A New Vision for California’s Healthcare System: Integrated Care with Aligned Financial Incentives

Cited by 9 publications

References 35 publications

Large Independent Primary Care Medical Groups

Large Independent Primary Care Medical Groups

Forecasts and Drivers of Health Expenditure Growth in California

The Berkeley Forum – A Roadmap for Improving Healthcare in California

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