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Health Aff (Millwood). 2017 Nov;36(11):1920-1927. doi: 10.1377/hlthaff.2017.0535.

Improving Care And Lowering Costs: Evidence And Lessons From A Global Analysis Of Accountable Care Reforms.

Author information

1
Mark McClellan ( Mark.McClellan@duke.edu ) is director of the Duke-Robert J. Margolis, M.D., Center for Health Policy and the Robert J. Margolis, M.D., Professor of Business, Medicine, and Policy, at Duke University, in Durham, North Carolina, and Washington, D.C.
2
Krishna Udayakumar is executive director of Innovations in Healthcare, Duke University, director of the Duke Global Health Innovation Center, and an associate professor of global health and medicine at Duke University in Durham.
3
Andrea Thoumi is a managing associate at the Duke-Robert J. Margolis, M.D., Center for Health Policy at Duke University in Washington, D.C.
4
Jonathan Gonzalez-Smith is a senior research assistant at the Duke-Robert J. Margolis, M.D., Center for Health Policy at Duke University in Washington, D.C.
5
Kushal Kadakia is an undergraduate research assistant at the Duke-Robert J. Margolis, M.D., Center for Health Policy at Duke University in Durham.
6
Natalia Kurek is a policy fellow at Imperial College London, in the United Kingdom.
7
Mariam Abdulmalik is general director at the Primary Health Care Corporation, in Doha, Qatar.
8
Ara W. Darzi is executive chair of the World Innovation Summit for Health, Qatar Foundation, and director of the Institute of Global Health Innovation, Imperial College London.

Abstract

Policy makers and providers are under increasing pressure to find innovative approaches to achieving better health outcomes as efficiently as possible. Accountable care, which holds providers accountable for results rather than specific services, is emerging in many countries to support such care innovations. However, these reforms are challenging and complex to implement, requiring significant policy and delivery changes. Despite global interest, the evidence on how to implement accountable care successfully remains limited. To improve the evidence base and increase the likelihood of success, we applied a comprehensive framework for assessing accountable care implementation to three promising reforms outside the United States. The framework relates accountable care policy reforms to the competencies of health care organizations and their health policy environments to facilitate qualitative comparisons of innovations and factors that influence success. We present emerging lessons to guide future implementation and evaluation of accountable care reforms to improve access to and the quality and affordability of care.

KEYWORDS:

Financing Health Care; Health Reform; International/global health studies; Organization and Delivery of Care

PMID:
29137499
DOI:
10.1377/hlthaff.2017.0535
[Indexed for MEDLINE]
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