Health Care Systems and HMOs

The United States has embarked on a major effort to achieve "meaningful use" of health information technology (HIT) by clinicians and hospitals. This paper, from The Commonwealth Fund's international program, describes meaningful use in three countries with very high levels of HIT adoption—Denmark, New Zealand, and Sweden. None has reached 100 percent in all meaningful use categories, but providers share many kinds of information with other health care organizations and health authorities. Less information is shared with patients. Useful strategies have included providing economic incentives to encourage adoption and designating an organization to take responsibility for standardization and interoperability.

This policy paper by Kelly Devers analyzes the trend toward quality improvement (QI) efforts in health care, concluding that while QI alone is no magic bullet, it generally has modest, positive effects. The paper, funded by the Robert Wood Johnson Foundation, reviews the evolution of QI initiatives, the current evidence about whether QI interventions work, QI’s promise for the future, and how to help it find success in health care. The paper offers recommendations for enhancing QI, including by providing incentives for providers to prioritize quality; improving education, training, and technical assistance; investing in health IT; and promoting greater collaboration across organizations.

This paper, from The Commonwealth Fund’s international program, examines the origins, content, and potential impact of England's evidence-based End-of-Life Care Strategy. Challenges addressed include moving such care beyond the province of hospice and palliative-care specialists and initiating palliative services before the patient's final days. Aspects of the English approach that may be useful in the U.S include helping physicians recognize when patients are entering a trajectory that may end in death, the use of "death at home" as a metric for measuring progress, improving the skills of clinical and caregiving personnel through Web-based training, and developing a national improvement pathway.

This issue paper examines the latest developments in accountable care organizations (ACOs), including a look at the final regulations on ACOs issued in October 2011 by the Centers for Medicare & Medicaid Services (CMS). Written by the Urban Institute’s Bob Berenson and Rachel Burton, this paper provides an overview of ACOs, the key complaints about CMS' proposed regulations and their resolution in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans. This paper is supported by the Robert Wood Johnson Foundation.

More than a decade after the successful mapping of the human genome, clinical genomics is starting to permeate important parts of patient care. Although the field has fallen far short of the transformational therapeutic impact once widely predicted, the use of genomic interventions is rising rapidly, if not always appropriately. Avoidable patient harm and excess costs mix with significant clinical and economic benefits. A health policy community long fluent in the argot of DRGs and billing codes needs to acquire similar proficiency in the language of DNA and genetic codes. This paper, by Michael Millenson, a senior policy consultant to the Urban Institute, examines what's hype, what's hopeful and what's starting to make a genuine difference in clinical genomics.