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How Can We Support the Transition to a Higher-Performing System?

What Challenges Are Involved in Moving to New Systems?

Our nation’s quest for a higher-performing health care system will involve a complicated transition process. Policy changes and shifting market dynamics create major challenges for consumers, hospitals, doctors, insurers, and others involved with our health care. Simultaneous demand for higher performance, lower cost, and better outcomes creates conflicting incentives and rewards, as well as concern about whether changes adversely affect our nation’s most vulnerable citizens. We have studied efforts to create systemwide change in health care programs, plans, hospitals, and other settings and developed recommendations for others who plan to pursue a similar course. Related publications include:

"Evaluating System Change: A Planning Guide." Methods brief. (April 2010). This methods brief provides guidance on planning effective evaluations of system change interventions. It begins with a general overview of systems theory and then outlines a three-part process for designing system change evaluations.
"Basing Health Care on Empirical Evidence" Reforming Health Care Issue Brief #3 (May 2010). This brief reviews initiatives under way to develop evidence of comparative effectiveness and put it into practice.
"Moving Research into Practice: Lessons from the U.S. Agency for Healthcare Research and Quality's IDSRN Program" (Implementation Science, March 2007). Looks at AHRQ’s Integrated Delivery Systems Research Network’s success in generating research findings that could be applied in practice.  
"Informed Participation in TennCare by People with Disabilities" (Journal of Health Care for the Poor and Underserved, November 2006). Examines informed health care choices made by nonelderly people with diverse impairments as Tennessee moved its Medicaid beneficiaries into a new managed care program.
"Evaluation of the Local Initiative Rewarding Results Collaborative Demonstrations" (October 2006). Reports on five California Medicaid health plans that implemented pay-for-performance incentives to improve adolescent well-care visits and well-baby visits, concluding that there is some evidence for the effectiveness of the financial incentives for well-baby care.  
“Crossing the Quality Chasm via Transformational Change” (October 2005). Reports on case studies of six hospitals transitioning to new systems.
"SSI Enrollees' Health Care in TennCare" (Journal of Health Care for the Poor and Underserved, May 2003). Looks at how well the needs of blind or disabled SSI enrollees were met when they were moved into a new Medicaid managed care system.

How Can Demonstration Efforts Be Sustained in Ongoing Programs?

Many programs aimed at improving health insurance coverage or outcomes run for a finite period. When the funding stops, what happens to the programs the funding supported? We have studied state and local projects and coalitions after their grants end, looking at continuity efforts, states’ role in sustaining programs, and expansion of capacity and coverage. We have also identified challenges that hamper these efforts. Related publications include:

"Cash and Counseling: Improving the Lives of Medicaid Beneficiaries Who Need Personal Care or Home- and Community-Based Services" (August 2007). Summarizes findings from five years of research on how each of three demonstration states implemented the Cash and Counseling program, and on how the programs affected consumers who participated, consumers’ paid and unpaid caregivers, and costs to Medicaid.
“When the Funding Stops: Do Grantees of the Local Initiative Funding Partners Program Sustain Themselves?" (Evaluation and Program Planning, May 2006.) Reviews the experiences of coalitions formed to help expand health coverage for low-income children, noting that most were able to sustain themselves after foundation funding ended. States inherited knowledgeable and skilled advocates that helped form networks to continue the grantees’ work.
"Expectations of Sustainability: What Do CKF Grantees and State Officials Predict Will Happen Once RWJF Funding Ends?" Covering Kids and Families Evaluation, Highlight Memo #21, (December 2005). Looks at efforts to sustain new community social services programs after initial funding ends.

How Can Health Informatics Improve Efficiency of Care?

Health information technologies hold promise for improving quality and consistency of care, but they have been adopted slowly and cautiously by practitioners. We are evaluating a major demonstration that provides financial incentives to small physician practices for adoption of these technologies to determine whether the incentives can drive use and positively affect patient outcomes. We have also studied consumer and provider preferences. Related publications include:

"Toward Understanding EHR Use in Small Physician Practices." (Health Care Financing Review, fall 2009). This article presents insights into the use of electronic health records (EHRs) by small physician practices participating in a Centers for Medicare & Medicaid Services pay-for-performance demonstration.
"Health Information Exchange: The Role of Safety-Net Providers." Trends in Health Informatics, Issue Brief #5 (June 2009). This brief reviews lessons learned from a 13-member panel convened to discuss barriers and catalysts safety-net providers face in integrating HIE.
"Personal Health Records: What Do Underserved Consumers Want?" Trends in Health Informatics, Issue Brief #4 (May 2007). Describes features of existing publicly available personal health records and assesses whether these features match the needs and preferences of underserved individuals.
"New Hospital Information Technology: Is It Helping to Improve Quality?" Trends in Health Care Quality, Issue Brief #3 (May 2006). Reports on how six types of information technology have affected hospital quality, based on interviews with senior hospital executives.
"Implementing Telemedicine Services for Low-Income Seniors: Potential Strategies" Trends in Health Informatics, Issue Brief #2 (September 2005). Suggests key factors for policymakers and funders of telemedicine interventions to consider as they move forward in developing initiatives for groups with little education and limited experience with technology.