Scanning the Headlines: Clinical Integration

Antitrust and other legal/regulatory issues re: clinical integration where hospitals and physicians work together, such as gainsharing, provision of physicians with IT, etc. Also any general discussion of clinical integration as it relates especially to caring for the patient with chronic disease across the continuum of care.

Updated on November 16, 2017

Links to full-text articles are provided where available.
For information on obtaining print copies of articles, please call the AHA Resource Center at (312) 422-2050.

(2017, Nov. 13). State Medicaid Integration Tracker©. Washington: National Association of States United for Aging and Disabilities. Retrieved from: http://nasuad.org/sites/nasuad/files/State%20Medicaid%20Integration%20Tracker%20November%202017%20Final.pdf

Lewis, Ph.D., V., Fisher, M.D., E., and Colla, Ph.D., C. (2017, Nov. 9). Sluggish Savings Under Accountable Care Organizations. Chicago: Physicians for A National Health Program. Retrieved from: http://www.pnhp.org/news/2017/november/sluggish-savings-under-accountable-care-organizations

Gratale, D., and Chang, D. (2017, Oct. 30). Defining an Accountable Community for Health for Children Families. Washington: National Academy of Medicine. Retrieved from: https://nam.edu/defining-an-accountable-community-for-health-for-children-and-families/

Lisle, K., and others. (2017, Oct. 4). The 2017 ACO Survey: What do current trends tell us about the future of accountable care? Health Affairs Blog. Retrieved from: http://healthaffairs.org/blog/2017/10/04/the-2017-aco-survey-what-do-current-trends-tell-us-about-the-future-of-accountable-care/

Hancock, J. (2017, Sept. 5). How below-the-radar mergers fuel health care monopolies. Kaiser Health News. Retrieved from: http://khn.org/news/how-below-the-radar-mergers-fuel-health-care-monopolies

Baker, L., Bundorf, K., and Kessler, D. (2017, Sept.). Does Multispecialty Practice Enhance Physician Market Power? Cambridge, MA: National Bureau of Economic Research. Retrieved from: http://www.nber.org/papers/w23871

Brown, G. "Population Health Support Organization Serves as New Infrastructure for Today's Population Health Needs" by Graham Brown, Accountable Care News, 8(9):1, 3, 4, Aug. 2017.

(2017, Aug.). Medicare Shared Savings Program Accountable Care Organizations Have Shown Potential for Reducing Spending and Improving Quality. Washington: Department of Health and Human Services. Retrieved from: https://oig.hhs.gov/oei/reports/oei-02-15-00450.pdf

Geva, A., and others. (2017, July 8). Provider Connectedness to Other Providers Reduces Risk of Readmission After Hospitalization for Heart Failure. Thousand Oaks, CA: Sage Publishers. Retrieved from: http://journals.sagepub.com/doi/abs/10.1177/1077558717718626

(2017, June). Analysis of Integrated Delivery Systems and New Provider-Sponsored Health Plans. Princeton, NJ: Robert Wood Johnson Foundation. Retrieved from: http://www.rwjf.org/en/library/research/2017/06/analysis-of-integrated-delivery-systems-and-new-provider-sponsor.html

McClellan, M., and others. (2017, May, 11). Accountable care around the world: Lessons and policy implications for the U.S. To the Point. Retrieved from: http://www.commonwealthfund.org/publications/blog/2017/may/international-examples-of-accountable-care

(2017, May 2). Post-Acute Care (PAC) Optimization in a Value-Based Economy: Bridging the Gap Between Hospital and Home. Chicago: Leavitt Partners. Retrieved from: https://leavittpartners.com/2017/05/post-acute-care-pac-optimization-in-a-value-based-economy-bridging-the-gap-between-hospital-and-home/

Hsu, J., and others. (2017, May). Bending the spending curve by altering care delivery patterns: The role of care management within a pioneer ACO. Health Affairs. 36(5):876-884. Retrieved from: http://content.healthaffairs.org/content/36/5/876.abstract

Phillips, G., and Abrams, M. (2017, Apr. 13). 3 best practices for partnering with post-acute providers for better care. H&HN. Retrieved from: http://www.hhnmag.com/articles/8207-partnering-with-post-acute-providers-for-better-care

(2016, Apr. 6). CMS' Accountable Health Communities Model Selects 32 Participants to Serve as Local 'Hubs' Linking Clinical and Community Services. Baltimore, MD: Centers for Medicare & Medicaid Services. Retrieved from: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-04-06.html

Whitman, E. (2017, Apr. 4). Inspecting the role of the physician in ACOs. Modern Healthcare. Retrieved from: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiGwrD00o3TAhVC9mMKHTL3DNoQFggoMAE&url=http%3A%2F%2Fwww.modernhealthcare.com%2Farticle%2F20170404%2FNEWS%2F170409996&usg=AFQjCNEtKK7VOepoummiBJw4Pq-_eIZCrQ&bvm=bv.151426398,d.amc

Hsu, J., and others. (2017, Apr.). Substantial physician turnover and beneficiary 'churn' in a large Medicare pioneer ACO. Health Affairs. 36(4):640-648. Retrieved from: http://content.healthaffairs.org/content/36/4/640.abstract

Schur, C., and Sutton, J. (2017, Apr.). Physicians in Medicare ACOs offer mixed views of model for health care cost and quality. Health Affairs. 36(4):649-654. Retrieved from: http://content.healthaffairs.org/content/36/4/649.full

McAlearney, A., Hilligoss, B., and Song, P. (2017, Mar. 17). Private sector accountable care organization development: A qualitative study. American Journal of Managed Care. Retrieved from: http://www.ajmc.com/journals/issue/2017/2017-vol23-n3/private-sector-accountable-care-organization-development-a-qualitative-study

Betbeze, P. (2017, Feb. 16). 4 success factors for clinically integrated networks. HealthLeaders Media. Retrieved from: http://www.healthleadersmedia.com/leadership/4-success-factors-clinically-integrated-networks

Cheney, C. (2017, Feb. 13). How to succeed in a Medicare ACO. HealthLeaders Media. Retrieved from: http://www.healthleadersmedia.com/finance/how-succeed-medicare-aco

(2017, Feb. 2). UnitedHealth, Aetna, Anthem Near 50% Value-Based Care Spending. Bhubaneswar: Medtel. Retrieved from: http://www.forbes.com/sites/brucejapsen/2017/02/02/unitedhealth-aetna-anthem-near-50-value-based-care-spending/

Neprash, H., Chernew, M., and McWilliams, J. (2017, Feb.). Little evidence exists to support the expectation that providers would consolidate to enter new payment models. Health Affairs. 36(2):346-354. Retrieved from: http://content.healthaffairs.org/content/36/2/346.full

Valuck, T., and others. (2017, Feb.). Improving oncology quality measurement in accountable care: Filling gaps with cross-cutting measures. Journal of Managed Care & Specialty Pharmacy. 23(2):174-181. Retrieved from: http://www.jmcp.org/doi/abs/10.18553/jmcp.2017.23.2.174

(2017, Feb.). Principles for Clinical Episode and Population-Based Payment Overlap. Health Care Transformation Task Force. Retrieved from: https://static1.squarespace.com/static/548b623fe4b0991231a05ff0/t/58b5e56a1e5b6c6b3d202353/1488315754486/HCTTF%2BPrinciples.pdf

Toyin, I. (2017, Jan. 25). Weaving whole-person health throughout an accountable care framework: The social ACO. Health Affairs Blog. Retrieved from: http://healthaffairs.org/blog/2017/01/25/weaving-whole-person-health-throughout-an-accountable-care-framework-the-social-aco/

Perrin, J., and others. (2017, Jan.). Pediatric Accountable Care Organizations: Insight From Early Adopters. Elk Grove Village, IL: American Academy of Pediatrics. Retrieved from: http://pediatrics.aappublications.org/content/early/2017/01/29/peds.2016-1840

(2017, Jan.). FACT SHEET: New Accountable Care Organization Model Opportunity: Medicare ACO Track 1+ Model. Baltimore: Department of Health & Human Services. Retrieved from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/New-Accountable-Care-Organization-Model-Opportunity-Fact-Sheet.pdf

Short, M., Ho, V., and McCracken, A. (2017, Jan.). The Integration and De-Integration of Physicians and Hospitals Over Time. Retrieved from: http://www.bakerinstitute.org/media/files/files/a89f9c05/CHB-pub-PHITrends-012417.pdf

(2017, Jan.). Noether, M., and May, S. Hospital Merger Benefits: Views from Hospital Leaders and Econometric Analysis. [Charles River Associates] Retrieved from: http://www.advancinghealthinamerica.org/wp-content/uploads/2014/08/Hospital-Merger-Full-Report_1.25.17.pdf

(2017). Hospital M&A: When Done Well, M&A Can Achieve Valuable Outcomes. Chicago: Deloitte. Retrieved from: https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-hospital-ma-report-v2.pdf

(2017). Levers of Successful ACOs. Washington: Health Care Transformation Task Force. Retrieved from: https://static1.squarespace.com/static/548b623fe4b0991231a05ff0/t/5a03853171c10b64691feb45/1510180146001/Levers+of+Successful+ACOs+%5B6%5D.pdf

(2017). Accelerating and Aligning Primary Care Payment Models. Baltimore, MD: HCP Lan (Health Care Payment Learning & Action Network). Retrieved from: https://hcp-lan.org/workproducts/pcpm-whitepaper-final.pdf

(2016, Dec. 15). Livingston, S. CMS unveils Medicare-Medicaid ACO model. Modern Healthcare. Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiamdXZp67RAhUs74MKHclVDycQFggaMAA&url=http%3A%2F%2Fwww.modernhealthcare.com%2Farticle%2F20161215%2FNEWS%2F161219937&usg=AFQjCNFYobZJhHtOqg1XPiDv2zOZpzHP2A&bvm=bv.142059868,d.amc

(2016, Dec.). Report on Congress. Washington: Department of Health & Human Services. Retrieved from: https://innovation.cms.gov/Files/reports/rtc-2016.pdf

(2016, Nov. 30). Accountable Care Organizations and Risk-Based Payment Arrangements: Strong Preference for Upside-Only Contracts. Chicago: Leavitt Partners. Retrieved from: http://leavittpartners.com/2016/11/accountable-care-organizations-and-risk-based-payment-arrangements-strong-preference-for-upside-only-contracts/

Fraze, T., and others. (2016, Nov.). Housing, transportation, and food: How ACOs seek to improve population health by addressing nonmedical needs of patients. Health Affairs. 35(11):2109-2115. Retrieved from: http://content.healthaffairs.org/content/35/11/2109.abstract

Morgan, A., and others. (2016, Nov.). Beyond books: Public libraries as partners for population health. Health Affairs. 35(11):2030-2036. Retrieved from: http://content.healthaffairs.org/content/35/11/2030.abstract

Muchmore, S. (2016, Oct. 26). Vermont's all-payer ACO will begin in January. Modern Healthcare. Retrieved from: http://www.modernhealthcare.com/article/20161026/NEWS/161029930

Liu, L., Svoboda, R., and Zhang, Y. (2016, Sept. 14). Using a modified next generation ACO benchmark can improve the MSSP. American Journal of Managed Care (AJMC). Retrieved from: http://www.ajmc.com/journals/ajac/2016/2016-vol4-n3/using-a-modified-next-generation-aco-benchmark-can-improve-the-mssp

Minemyer, P. (2016, Sept. 12). In wake of ACO exits, Dartmouth leaders explain decision to scrap model. FierceHealthcare. Retrieved from: http://www.fiercehealthcare.com/healthcare/dartmouth-s-departure-leaves-questions-about-future-aco-model

(2016, Sept.). Physician Practice Acquisition Study: National and Regional Employment Changes. Physicians Advocacy Institute. Retrieved from: http://www.physiciansadvocacyinstitute.org/Portals/0/PAI-Physician-Employment-Study.pdf

Pines, J., and others. (2016, Aug. 18). Aligning payment reform and delivery innovation in emergency care. American Journal of Managed Care. Retrieved from: http://www.ajmc.com/journals/issue/2016/2016-vol22-n8/aligning-payment-reform-and-delivery-innovation-in-emergency-care

Budryk, Z. (2016, July 20). 3 Next Generation ACOs bow out of shared savings program. FierceHealthcare. Retrieved from: http://www.fiercehealthcare.com/healthcare/3-next-generation-acos-bow-out-program

Abrams, M., and Phillips, G. (2016, July 13). Why post-acute care partners are critical to hospitals' future. H&HN. Retrieved from: http://www.hhnmag.com/articles/7421-why-post-acute-care-partners-are-critical-to-hospitals-future

Stempniak, M. (2016, July 7). 7 outdated legal barriers keeping docs, hospitals from transforming health care. H&HN. Retrieved from: http://www.hhnmag.com/articles/7433-outdated-legal-barriers-keeping-docs-hospitals-from-transforming-health-care

(2016, July 5). Legal (Fraud and Abuse) Barriers to Care Transformation and How to Address Them. Chicago: American Hospital Association. Retrieved from: http://www.aha.org/system/files/content/16/barrierstocare-full.pdf

Weaver, D. (2016, June 29). M&A Not Your Thing? Here's the Deal on Alternative Network Models. Washington: Advisory Board. Retrieved from: https://www.advisory.com/research/health-care-advisory-board/blogs/at-the-helm/2016/06/sw-alternative-network-models

Lee, P. (2016, June 9). Who makes sure hospital mergers do no harm? Almost nobody. Pro Publica. Retrieved from: https://www.propublica.org/article/who-makes-sure-hospital-mergers-do-no-harm-almost-nobody

Dickson, V. (2016, June 6). CMS finalizes changes to ACO cost targets. Modern Healthcare. Retrieved from: http://www.modernhealthcare.com/article/20160606/NEWS/160609943/cms-finalizes-changes-to-aco-cost-targets

Keckley, P. (2016, June 1). The ACO curveball: What the IRS ruling means. H&HN. Retrieved from: http://www.hhnmag.com/articles/7316-the-aco-curveball-what-the-irs-ruling-means

(2016, June). Accountable Care Financial Arrangements: Options and Considerations. Health Care Transformation Task Force. Retrieved from: http://static1.squarespace.com/static/548b623fe4b0991231a05ff0/t/5759cde420c6479e68bb5059/1465503204766/HCTTF_ACO+Financial+Arrangements+White+Paper.pdf

Konetzka, T., and others. (2016, June). The Effect Integration of Hospitals and Post-Acute Care Providers on Medicare Payment and Patient Outcomes. Chicago: University of Chicago. Retrieved from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2805172

Anderson, J. (2016, June). ACOs add telehealth, despite regulatory, reimbursement barriers to implementation. AISHealth. Retrieved from: https://aishealth.com/archive/nvbc0616-02?utm_source=Real%20Magnet&utm_medium=Email&utm_campaign=97479176

Heider, F., Kniffin, T., and Rosenthal, J. (2016, May). State Levels to Advance Accountable Communities for Health. Washington: National Academy for State Health Policy. Retrieved from: http://www.nashp.org/wp-content/uploads/2016/05/ACH-Brief-with-Appendix.pdf

(2016, May). ACO Cost and MACRA Implementation Survey. Princeton Junction, NJ: National Association o9f ACOs (NAACOS). Retrieved from: https://www.naacos.com/news/NAACOS-CostandMACRA-Survey-5.24.2016_Final.pdf

Horrocks, D., Kinzer, D., and others. (2016, Apr. 25). The adequacy of individual hospital data to identify high utilizers and assess community health. Journal of the American Medical Association. Retrieved from: http://archinte.jamanetwork.com/article.aspx?articleid=2516764

Muhlestein, D., and McClellan, M. (2016, Apr. 21). Accountable care organizations in 2016: Private and public-sector growth and dispersion. Health Affairs Blog. Retrieved from: http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/

Ciarametaro, M., and Dubois, R. (2016, Apr. 20). Designing successful bundled payment initiatives. Health Affairs. Retrieved from: http://healthaffairs.org/blog/2016/04/20/designing-successful-bundled-payment-initiatives/

Dawe, C., Lewine, N., and Miesen, M. (2016, Apr. 15). Today's most attrative national ACO model is offered by...CMS. Health Affairs Blog. Retrieved from: http://healthaffairs.org/blog/2016/04/15/todays-most-attractive-national-aco-model-is-offered-bycms

Dale, S., Ghosh, A., Peikes, D., and others. (2016, Apr. 13). Two-year costs and quality in the comprehensive primary care initiative. New England Journal of Medicine. Retrieved from: http://www.nejm.org/doi/pdf/10.1056/NEJMsa1414953

McWilliams, J., Hatfield, L., Chernew, M., and others. (2016, Apr. 13). Early performance of accountable care organizations in Medicare. Retrieved from: http://www.nejm.org/doi/pdf/10.1056/NEJMsa1600142

Steele, G., and Dafny, L. (2016, Apr. 5). When do provider-sponsored health plans make sense? Part 2. New England Journal of Medicine. Retrieved from: http://catalyst.nejm.org/when-do-provider-sponsored-health-plans-make-sense-part-2

Shortell, S. (2016, Apr. 5). Applying organization theory to understanding the adoption and implementation of accountable care organizations. Medical Care Research and Review. Retrieved from: http://mcr.sagepub.com/content/early/2016/04/05/1077558716643477.abstract

Gray, E., and Aronovich, R. (2016, Apr.). Producing an ROI with a patient-centered medical home. Healthcare Financial Management. Retrieved from: https://www.hfma.org/Content.aspx?id=47225

Gruessner, V. (2016, Mar. 15). Value-Based Care Reimbursement Needs Greater Customization. Danvers, MA: Xtelligent Media, LLC. Retrieved from: http://revcycleintelligence.com/news/value-based-care-reimbursement-needs-greater-customization

Higgins, A., Stewart, K., Picarillo, G., and others. (2016, Mar. 14). Health plan-provider accountable care partnerships: How have they evolved? American Journal of Managed Care. Retrieved from: http://www.ajmc.com/journals/ajac/2016/2016-vol4-n1/health-plan-provider-accountable-care-partnerships-how-have-they-evolved

Perla, R., and Onie, R. (2016, Mar. 2). Accountable health communities and expanding our definition of health care. Health Affairs Blog. Retrieved from:

Clinical Integration