ShortellPopulation Health News conducted an interview with CHOIR Director Stephen Shortell to discuss integrated care delivery systems, care quality and population health management, patient engagement, and organizational partnerships. Read an excerpt from the interview below and download the full interview here.


Population Health News: The industry touts integrated delivery systems, such as accountable care organizations, patient-centered medical homes, Kaiser and like organizations, but what will it take to move the entire healthcare system forward in their direction?

Stephen Shortell: One way of thinking about this question is in terms of incentives on one hand and capabilities on the other hand. Both are needed to move the system toward more integrated care. Incentives that move away from fee-for-service payment toward value-based payment based on outcomes of care create the motivation for changing how care is delivered.

CMS is moving strongly in this direction with such payment innovations as shared savings arrangements with accountable care organizations (ACOs), bundled payments and the recently announced MACRA payment reform legislation that will reward doctors with a 5% bonus if they choose to practice in an ACO-like entity. They also could choose to be paid under an incentive program that depending on their ability to meet cost and quality metrics will reward them with additional income; however, If they fail to meet the metrics, they will be subject to loss of income.

But incentives alone are insufficient. One also needs to take into account the capabilities of providers to respond to the incentives, and this varies widely across the United States. Hence comes the need to calibrate the pace of change in rolling out new payment models with the ability of providers to respond to risk-based payments. It is encouraging that a number of technical assistance programs are being made available to small physician practices to acquire some of the skills that will be needed to succeed under the new value/risk-based payment models. These include support of electronic health record implementation, formation of healthcare teams, training in patient engagement methods, the use of health coaches and related approaches