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Insights from Emerging Health Care Delivery Models Examined in Health Affairs' November 2012 Issue


Articles cover four key areas of costs, spending, quality and outcomes


Bethesda, MD --The November 2012 issue of Health Affairs covers a variety of topics, including learnings from accountable care organizations (ACOs) and patient-centered medical homes. It also provides analyses of sources of health spending for employers and other payers--including how common health risk factors account for a sizeable portion of costs for employees' health care, and how physicians with relatively little experience account for more spending than those with more experience. With an eye toward learning from experiences overseas, it offers a look at how China has managed to drastically expand health insurance coverage--to an astounding 95 percent of its population.


Featured articles include:


Depression leads a list of ten risk factors linked to more than one-fifth of employer and employee health spending. Ron Goetzel, a research professor and the director of Emory University's Institute for Health and Productivity Studies, and vice president of consulting and applied research for Truven Health Analytics, and coauthors matched health spending for 92,000 employees at seven organizations over three years with a list of ten common risk factors. They discovered that 22.4 percent of the $366 million spent annually by the seven employers and their employees was attributed to the ten risk factors, all of which could be addressed by a combination of the appropriate health care and behavioral interventions.


High risk for depression led the list. The additional annual medical expenditure for an employee with depression was $2,185 higher--or 48 percent more--than for a worker without depression. High blood glucose ($1,653 more), high blood pressure ($1,378 more), and obesity ($1,090 more) were also strongly related to increased health care costs. Workers who were physically inactive ($606 more), used tobacco ($587 more), or had high stress ($343 more) also incurred higher costs for themselves and their employers than workers who did not.


Physicians with the least experience account for more health care spending than physicians with the most experience. Ateev Mehrotra, a policy analyst at the Rand Corporation, and coauthors analyzed the cost profiles of more than 12,000 physicians practicing in Massachusetts. Physician cost profiles provide a picture of the interventions performed by different physicians and are being used by Medicare and private plans to identify which physicians account for more health care spending.


The researchers found that physicians with fewer than ten years of experience accounted for 13.2 percent higher overall costs than did physicians with forty or more years of experience. The researchers did not find any other association between costs and other physician characteristics, including having paid malpractice claims, being subject to disciplinary action, gender, size of physician group, and board certification status. The results raise the possibility that the more costly practice style of newly trained physicians may be a driver of rising health care costs overall.


China's massive investment in access to health insurance and care facilities is beginning to bear fruit. China's Health Minister Chen Zhu was interviewed by Tsung-Mei Cheng, health policy research analyst at the Woodrow Wilson School of Public and International Affairs at Princeton University, on early results of China's 2009 health reforms. Huge investments in insurance coverage, health care facilities, and the health care workforce have resulted in more than 95 percent of China's population of 1.34 billion now having some form of health insurance, according to China's Health Ministry. The capacity to deliver care to the Chinese has been greatly expanded, with one community health services center now located on every street in every one of China's cities.


It's too soon to fully gauge the effectiveness of ACOs or patient-centered medical homes, but no one can say that they aren't off and running. Nine articles offer early insights on ACO and patient-centered medical home care delivery models, both of which have made significant headway in a relatively short period of time. ACOs, in particular, have seen considerable momentum--from a standing start just two years ago, to more than 300 ACOs now operating in forty-eight states.


The goal of both models is to more tightly coordinate care and improve the health of patients, but no one is sure whether either model will deliver major cost savings, especially right away. Articles include the following:


  • Accountable Care Organizations May Have Difficulty Avoiding the Failures of Integrated Care Networks of the 1990s
    Lawton Burns is chair of the Health Care Management Department at the Wharton School of the University of Pennsylvania.

  • A Framework for Evaluating the Formation, Implementation, and Performance of Accountable Care Organizations
    Elliott Fisher is director of the Center for Population Health at the Dartmouth Institute for Population Health and Clinical Practice.

  • Insights from Transformations Under Way at Four Brookings-Dartmouth Accountable Care Organization Pilot Sites
    Bridget Larson is the former director of health policy implementation at the Dartmouth Institute for Health Policy and Clinical Practice.

  • Many Accountable Care Organizations Are Now Up and Running, If Not Off to the Races
    Harris Meyer is a freelance writer based in Yakima, Washington.

  • Small Primary Care Practices Face Four Hurdles--Including a Physician-Centric Mind-Set--In Becoming Medical Homes
    Paul Nutting is a professor of family medicine at the University of Colorado Health Sciences Center and the director of research at the Center for Research Strategies.

  • Results from a Patient-Centered Medical Home Pilot at UPMC Health Plan Hold Lessons for Broader Adoption of the Model
    Cynthia Napier Rosenberg was senior medical director for network management and provider relations at UPMC Health Plan.

  • A Collaborative Accountable Care Model in Three Practices Showed Promising Early Results on Costs and Quality of Care
    Richard B. Salmon is national medical executive, performance measurement and improvement, at Cigna.

  • An Academic Health Center Sees Both Challenges and Enabling Forces As it Creates an Accountable Care Organization
    Alfred F. Tallia is chair of the Department of Family Medicine and Community Health at the Robert Wood Johnson Medical School.

  • About Half of the States Are Implementing Patient-Centered Medical Homes for their Medicaid Populations
    Mary Takach is a program director for the National Academy for State Health Policy.
About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.