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2009 NAP Forum Policy Paper
now available!
 NAP Policy Paper on
Accountable Health
Systems calls for a broader interdisciplinary approach
to system design
Using the Commonwealth Fund's reports on developing a high performance U.S. health care system as a starting point, NAP has developed a new policy paper titled "Models of Accountable Coordinated Health Care," the creation of which was partially supported by a grant from the Commonwealth Fund.
Developed through a process of literature review, consideration of expert presentations made a the national NAP Forum meeting, and group discussion, the purpose of this paper is to showcase the voice of the practitioner on this aspect of health care reform.
This official paper from the NAP 2009 Forum is now available! Click here to read the findings.
NAP Debates Reform at 2009 Forum
 At a crucial time in health care reform in the United States, more than 160 NAP members took time from their busy schedules to share their expertise and advise public policy makers. The ratings were excellent! The 2009 NAP Forum, sponsored in part by a grant from the well-respected Commonwealth Fund, took place March 27-28 in Arlington, VA and drew distinguished NAP members and others from all over the country who were eager to make their voice heard at this critical juncture. With healthcare reform being seriously debated and proposed actions to be reviewed as early as this summer, the timing of this event could not have been better.
On Saturday, March 28, attendees tackled the weighty issue of care coordination in a Forum titled, “Transforming Healthcare: Models of Accountable Interdisciplinary Care Coordination that Work.” An NAP Policy paper will be drafted on this important topic. Here’s a brief look at the day:
 Transforming Healthcare –
Anne Gauthier, Asst. Vice President,
Commonwealth Fund & Deputy Director for
the Commission on a High Performance Health System
Ms. Gauthier began the day examining the challenges that lay before us. The Commonwealth Fund is a non-profit, non-partisan, private organization which aims to promote a high performing health care system by supporting and conducting independent research on health care issues and making grants to improve health care practice and policy. In 2005, the Commission on a High Performance Health System was created to improve healthcare through better access, improved quality and greater efficiency, with particular focus on the most vulnerable populations.
The Commission measures how the Health System is performing through a National Scorecard on U.S. Health System Performance. The scorecard measures results in 5 key areas: healthy lives, quality, access, efficiency and equity.
The 2006 scorecard of the health system was much better than the more recent 2008 scorecard. Declines were seen in almost all areas of measurement. Ms. Gauthier shared the solution of the Commission, which is to drive five key strategies at once:
- Affordable coverage for all
- Align incentives with value and effective cost control
- Accountable, accessible, patient-centered and coordinated care
- Aim high to improve quality, health outcomes and efficiency
- Accountable leadership and collaboration to set and achieve national goals
After sharing some innovative models of effective coordinated care, she closed with a
challenge to the group to drive this agenda through:
- Collecting data on how these and other models of coordinated care are working
- Learning and teaching best practices
- Practicing shared decision-making by engaging patients
- Adopting information technology
- Supporting leaders and policies by talking to public officials about the challenges and concerns of healthcare
 Keynote Speaker –
Robert Berenson, MD
Sr. Fellow in Health Policy Urban Institute
National expert and Senior Fellow in Health Policy Dr. Berenson gave a talk aimed at outlining what we know and don’t know about accountable care coordination models. He began by laying out the needs of those with chronic conditions and explaining the pressures this population places on the healthcare system in the current environment. In the face of this overwhelming pressure, it is more difficult than ever for care providers to spend the time and energy needed to provide coordinated, accountable care, explained Berenson.
Discussing models of care coordination that have failed, Berenson shared some common reasons for this outcome, saying that discussions of care coordination suffer from a lack of clarity on:
- Target populations
- Definitions and specifications of the various interventions
- Locus of activity/organizational sponsorship
He then went on to discuss promising models being tested, such as Medical Homes and home-based primary care.
 Medical Home Model –
Michael Barr, MD, MBA, FACP
VP, Center for Practice Innovation
American College of Physicians
After discussing the poor state of the nation’s health care, including escalating costs and decreasing coverage, Dr. Michael Barr shared the case for healthcare reform, including:
- Poor access to care, especially for the uninsured
- Escalating costs and volume of services
- No link between cost and quality
- Excessive administrative costs
- Dysfunctional payment system
- US lagging behind internationally
- Impending “collapse” of primary care
Discussing the Medical Home Model, he also shared what he felt were the “required ingredients” of a collaborative system:
- Patient capable of sharing in medical decisions
- Prepared, well-organized health care team
- Practice to level of license, skill, ability – no lower
- High technology + high touch
- Organizational support
- Resources
 Health Care Community™ –
Marie DiCowden, PhD
Exec. Director, Biscayne Institute of Health and Living
Marie DiCowden, PhD, began by discussing the nature of the Biscayne Institute, which is a community based model that offers frontline health services for health care across the continuum. To be a trademarked HealthCare Community™, there must be services for
- Health Prevention and Promotion
- Integrated Primary Care
- Rehabilitation
The Biscayne Institutes HealthCare Community additionally includes several unique features:
- Academy Program - offering a special school program for 50 plus children, including education, physical and psychological health care
- Volunteer and Protected Work Environment - providing work situations for adults who are not able to participate in a regular work environment
- Interprofessional Research and training
- Community outreach
 VA Home-Based Primary Care Model –
Thomas Edes, MD
Chief, Home & Community-based Care, Department of Veteran Affairs
VA Home-based medical care is:
- Comprehensive, longitudinal primary care
- Delivered in the home
- Delivered by an interdisciplinary team: Nurse, Physician, Social Worker, Rehabilitation Therapist Dietitian, Pharmacist, Psychologist
- Targets patients with complex, chronic, disabling disease
- Used when routine clinic-based care is not effective
Home-based Primary Care is different than Medicare Home Care because it:
- Serves a different target population
- Has a different process
- Produces different outcomes
HBPC provides longitudinal comprehensive, interdisciplinary care to veterans with complex chronic disease. The team includes:
- Program Director – social worker or nurse
- Medical Director – physician, primary care, oversight
- Nurse – nurse practitioners, registered nurses
- Social worker – family, finances, support
- Rehabilitation therapist – occupational or physical
- Dietitian – 80 to 90% warrant nutritional management
- Mental Health Provider – psychologist
- Pharmacist – medication reviews, team meeting
 Interdisciplinary Small Groups:
Discussion of Models and Policy
Facilitator: Elizabeth Rider, MSW MD, FAAP
Director of Programs for Comm. Skills,
John D. Stoeckle Ctr for Primary Care Innovation
Massachusetts General Hospital, Boston, MA
Dr. Beth Rider led the afternoon session where participants broke into small groups to debate issues regarding coordinated care that will be included in NAP’s policy paper on this issue. The Commonwealth Fund, who helped sponsor our event, is helping to widely publicize the Policy Paper that will include these findings. For more details on the final report from this meeting and the goals we share with the Commonwealth Fund, go to: www.commonwealthfund.org/publications.
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