On Monday a group of health policy experts came together at AEI to discuss the future of delivery system reform. Brent James, formerly of Intermountain Healthcare, began by surveying the process and imperatives behind successful delivery system transformation. In particular he focused on how financial incentives, when properly aligned and informed by quality data, can be leveraged to promote efficiency and improve clinical outcomes.
Next, an expert panel moderated by AEI’s Joseph Antos discussed the challenges for implementing successful reform. Elliot Fisher of the Dartmouth Institute for Health Policy and Clinical Practice discussed why progress with Accountable Care Organizations (ACOs) has been sluggish and what lessons can be learned to improve the ACO model going forward. Farzad Mostashari of Aledade discussed issues with consolidation and ACOs and how to foster competition within a framework that still encourages collaboration. Jeff Selberg of the Peterson Center on Healthcare highlighted additional research on innovative reform models and offered his thoughts on how best to promote such practices. Lastly, AEI’s James Capretta emphasized how success in this space requires a bottom-up approach, in which quality is not only a goal but also a necessity to operating a successful health enterprise.
The Obama administration launched an ambitious agenda to cut the cost and improve the quality of the health care patients receive. This agenda included creating Accountable Care Organizations and other payment approaches aimed at rewarding high-value care. In addition, Congress passed legislation in 2015 requiring the Centers for Medicare and Medicaid Services to develop a new Medicare payment system for physician services based on the same philosophy.
How well has the Obama-era delivery reform agenda worked? Where has the effort fallen short? How should the Trump administration modify this agenda to improve the productivity and quality of services? A panel of nationally recognized experts will explore these questions at a pivotal moment as the new administration develops its own agenda to reform the health care system.
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James C. Capretta, AEI
Brent James, Intermountain Healthcare (ret.)
James C. Capretta, AEI
Elliott Fisher, Dartmouth Institute for Health Policy and Clinical Practice
Brent James, Quality Science
Farzad Mostashari, Aledade
Jeff Selberg, Peterson Center on Healthcare
Joseph Antos, AEI
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Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI, where his research focuses on the economics of health policy — including the Affordable Care Act, Medicare, the uninsured, and the overall reform of the health care system and its financing. He also studies the impact of health care expenditures on federal budget policy. Before joining AEI, Dr. Antos was assistant director for health and human resources at the Congressional Budget Office (CBO). He has also held senior positions in the US Department of Health and Human Services, the Office of Management and Budget, and the President’s Council of Economic Advisers. He recently completed a seven-year term as health adviser to CBO and two terms as a commissioner of the Maryland Health Services Cost Review Commission. Dr. Antos has a Ph.D. and an M.A. in economics from the University of Rochester and a B.A. in mathematics from Cornell University.
James C. Capretta is a resident fellow and holds the Milton Friedman Chair at AEI, where he studies health care, entitlement, and US budgetary policy, as well as global trends in aging, health, and retirement programs. Mr. Capretta spent more than 16 years in public service before joining AEI. As an associate director at the White House’s Office of Management and Budget from 2001 to 2004, he was responsible for all health care, Social Security, welfare, and labor and education issues. His published essays and reports include “Improving Health and Health Care: An Agenda for Reform” (AEI, 2015) and “Increasing the Effectiveness and Sustainability of the Nation’s Entitlement Programs” (AEI, 2016). He has an M.A. in public policy studies from Duke University and a B.A. in government from the University of Notre Dame.
Elliott Fisher is the director of the Dartmouth Institute for Health Policy and Clinical Practice and the John E. Wennberg Distinguished Professor of Health Policy, Medicine, and Community and Family Medicine at the Geisel School of Medicine at Dartmouth. Dr. Fisher has led seminal research on the promise and perils of using large administrative databases for health care research, work that helped validate the quality of the data and demonstrated how such data could be used to answer important epidemiologic and policy questions. His current research focuses on evaluating how innovations in payment and care delivery are being implemented in the US health care system and the impact of these changes on health system performance. He now leads one of three federally funded US Centers of Excellence in Health Systems Research that is applying an implementation science framework to exploring the impact of new payment and delivery models and how the effectiveness of different models varies according to different organizational, market, and policy contexts. He has published more than 150 research articles and commentaries. He received his undergraduate and medical degrees from Harvard University and completed his internal medicine residency and public health training at the University of Washington. He serves on the boards of the Institute for Healthcare Improvement and the Fannie E. Rippel Foundation and is a member of the National Academy of Medicine.
Brent James is known internationally for his work in clinical quality improvement, patient safety, and the infrastructure that underlies successful improvement efforts, such as culture change, data systems, payment methods, and management roles. He is a member of the National Academy of Medicine and a fellow of the American College of Physician Executives. He is a clinical professor at Stanford University School of Medicine, a visiting lecturer at Harvard School of Public Health, an adjunct professor at the University of Utah School of Medicine, and an adjunct professor at the University of Sydney, Australia, School of Public Health. Dr. James was formerly chief quality officer and executive director for the Institute for Healthcare Delivery Research at Intermountain Healthcare. Through the Intermountain Advanced Training Program in Clinical Practice Improve¬ment, he has trained more than 5,000 senior physician, nursing, and administra¬tive executives in clinical management methods, with proven improvement results. He has been honored with several awards for quality in health care delivery, including the Deming Cup from the Columbia University School of Business (2011). Before coming to Utah in 1986, he was assistant professor in the Department of Biostatistics at the Harvard School of Public Health and staffed the American College of Surgeons’ Commission on Cancer. He holds bachelor of science degrees in computer science (electrical engineering) and medical biology, an M.D. degree (with residency training in general surgery and oncology), and a master of statistics degree. He serves on several nonprofit boards of trustees dedicated to clinical improvement and patient safety.
Farzad Mostashari is the cofounder and CEO of Aledade Inc. He has spent his career at the forefront of health care policy and health information technology (IT). Dr. Mostashari is the former national coordinator for health IT at the Department of Health and Human Services and served as a distinguished expert at the Brookings Institute’s Engelberg Center for Health Care Reform. Before his work at the Office of the National Coordinator, he founded the New York City Primary Care Information Project, which equipped 1,500 physicians in underserved communities with electronic health records. He has spoken and written extensively on issues affecting health IT, Accountable Care Organizations , and health care policy and delivery. He has been published in The New York Times, the Journal of American Medical Association, and Health Affairs, among others. Dr. Mostashari received his M.D. from Yale University School of Medicine and his master’s in population health from Harvard T.H. Chan School of Public Health.
Jeff Selberg is an adviser and former executive director at the Peterson Center on Healthcare. He previously served as the executive vice president and CEO for the Institute for Healthcare Improvement (IHI), where he worked closely with the leadership team to develop strategic partnerships, innovate new models of care, and develop and spread new definitions of patient safety. Before IHI, he served as president and CEO of Exempla Healthcare in Colorado, and he has served in several other executive leadership roles with health care institutions, including as president and CEO of Southwest Washington Medical Center and executive vice president for Good Samaritan Hospital and Medical Center in Oregon. Throughout his career, Mr. Selberg has focused on improving patient safety and clinical outcomes in patient care through the combination of system principles and the development of highly functioning teams.