Delivery Approaches

The administration and organization of health care systems, hospital networks, and other settings affect health, quality of care, and patient satisfaction—not to mention costs. Over the past decade, alternative models for delivering care have expanded in the United States. The goal of these models is to develop integrated payment and delivery systems that provide higher quality and more cost-effective care. Two examples of these arrangements are medical homes and ACOs.

Medical homes are integrated practices intended to improve quality and cost efficiency by putting patients at the center of a provider network. RAND analysis found that transforming practices into medical homes is complex and difficult. An evaluation of a large federal experiment to transform safety net practices into medical homes showed mixed results; overall practices that transformed showed only modest gains in quality and efficiency. However, medical home arrangements with better communication lead to high levels of patient satisfaction.

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other providers who join together voluntarily to give coordinated care to their patients. The goal is to avoid unnecessary duplication of services and improve patient safety. Following passage of the ACA, a large number of Medicare ACOs formed. RAND analysis found that ACO formation was associated with greater health system integration but not with higher medical costs. More recent analysis showed that hospitals participating in ACOs or other innovative Medicare arrangements showed a reduction in rehospitalizations, a key measure of hospital quality.

Other innovative arrangements continue to emerge. For example, some hospitals are using a new model of management that blends physicians and nurse practitioners. A controlled trial found that this arrangement was cost-effective and reduced the need for post-hospital care.