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Nielsen Survey Shows Gaps in How Patients Are Experiencing Accountable Care

 

Care Coordination Improving, Technology and 24/7 Access Not Widely Available, and Preventive Primary Care Critically Lacking

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WASHINGTON, D.C. (June 15, 2016) – A new Council of Accountable Physician Practices (CAPP)-sponsored Nielsen Strategic Health Perspectives survey released today reveals that only half of patients are experiencing the benefits of coordinated care and only about one-third have 24/7 access to care outside of the emergency department. The report also finds sluggish progress in the use of health information technology to connect doctors and patients, and that patients, including those who are obese and at risk for chronic illness, do not report receiving prevention counseling from their physicians.

The 2016 Nielsen Strategic Health Perspectives surveyed 30,007 U.S. consumers and 626 physicians. It is the second annual survey that CAPP sponsored to monitor the progress of meaningful healthcare delivery reform and the movement toward accountability.

“This survey is evidence of the failure of American healthcare to provide coordinated, technologically enabled, high-quality healthcare to the majority of people,” said Robert Pearl, M.D., Chairman of CAPP, and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. “We know that CAPP members, all committed to the multi-specialty medical group model, are best positioned to deliver superior outcomes to the patients they treat. CAPP stands ready to help others improve their care delivery systems, and to work with policymakers to facilitate these changes. These findings reinforce CAPP’s long-held belief that patient-centered care models are critical to closing the gaps between what patients need and what they are currently receiving.”

The survey measured respondents’ experiences with the five patient benefits associated with effective accountable care: care team coordination, prevention, 24/7 access, evidence-based medicine, and patient and physician access to and use of robust information technology.

Data from the survey shows that:

  • Eighty-nine percent of primary care physicians say they often remind patients about preventive screenings, but only 14 percent of patients say they get these reminders. More than two-thirds of adult Americans are overweight or obese, yet only 5 percent of patients report that their physicians recommended a weight-loss program.
  • Only half of patients are experiencing physicians who better know their history, primarily due to the ability to share information through electronic medical records. However, patients with multiple chronic illnesses, who would most benefit from care coordination, receive only slightly more follow-ups and care management as everyone else.
  • Patients’ electronic engagement with physicians is increasing but still low, with 20 to 30 percent of the total surveyed reporting that they have various forms of digital access like online submission of medical questions, email or text reminders. Roughly 44 percent report access to online information, such as appointment scheduling, obtaining lab test results, or viewing information via portals. Older Americans are less likely to want to use digital technology for healthcare, which presents a challenge in fully leveraging this technology to improve care delivery to this population.
  • Only about one-third have 24/7 access to care through their physician’s office other than the emergency room.
  • Sixty-five percent of physicians report using evidence-based guidelines to help determine treatment, with 39 percent of patients recalling discussions on new treatment options.

The leaders of CAPP, a coalition of leading integrated multi-specialty medical groups and health systems across the U.S. have long been committed to accountable, physician-led, patient-centered care. CAPP Executive Director Laura Fegraus said, “Our survey found that while it is encouraging that the use of care teams and care coordination seem to be increasing, access and the effective use of technology still need improvement, and tactics that help to prevent illness are still woefully ineffective.”

patient report cardWhile these results show that delivery system reform is beginning to move in the right direction, the work is far from over. CAPP supports policy initiatives that can expedite performance in accountable care, including payment reform to support “system-ness” and better outcomes; more robust health information technologies to improve sharing of information among providers and easier access by consumers; and standardized quality measures in language consumers can understand.

For more information on the survey findings, click here.

These survey results were presented and discussed today at a joint forum presented by CAPP and the Bipartisan Policy Center: “Better Together Health: Patient Expectations and the Accountability Gap,” held at the Center for Total Health in Washington, D.C.

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New Legislation Aims to Make Telehealth a Broad Reality

By Steven Green, MD
Chief Medical Officer, Sharp Rees-Stealy Medical Group
Secretary, Council of Accountable Physician Practices

The Council of Accountable Physician Practices (CAPP) is encouraged and excited by recent movement on Capitol Hill to expand access to telemedicine services in the Medicare program. For example, the CONNECT for Health Act, a bipartisan bill authored by Senators Brian Schatz (D-HI) and John Thune (R-SD) will create new opportunities for Medicare beneficiaries to receive high-quality, convenient care through telehealth. Like many of the medical groups in CAPP, my organization, Sharp Rees-Stealy Medical Group (SRSMG), was an early adopter of telemedicine, and we embrace its value, particularly when the technology is applied appropriately, backed by coordinated, organized systems and used to enhance existing patient and physician relationships.

Despite the barriers in regulation and legislation, Sharp-Rees Stealy has moved forward with testing and implementation of novel ways to deliver care via telehealth, including using video visits with our patients. As you can see from Felipe’s story here, the experience for both the patient and our physicians has been remarkable. As noted in this video, we see the potential of telemedicine to expand the capacity of our delivery system to serve our patients more effectively and efficiently while maintaining the high quality care they expect. Removing the barriers that exist with telemedicine will allow more patients to experience from the kind of service and quality that Felipe enjoys.

We know that we have much ground to cover if we hope to bring technologically-enabled care to everyone who needs it. Further improvements in reimbursement for telehealth services will lead to appropriate expansion of these modalities other payers so that accountable, coordinated groups like ours can deliver care to our patients when and where they need it most.

Watch Highlights of the 2015 “Better Together Health” Event

Challenging the Digital Divide Between Patients and Doctors

By Laura Fegraus, Executive Director, Council of Accountable Physician Practices

 

If you’re like most Americans, you make your travel reservations online, do your personal banking online, and use your phone to board a plane.

And if you’re like most Americans, you can’t perform any of those digital transactions with your doctor’s office. You most likely don’t have the option of texting your doctor, making an appointment by e-mail, checking your medical records online, or having a video visit with your doctor when it’s convenient to you.

This digital divide was dramatically revealed in the results of a Nielsen Strategic Health Perspectives Survey – “How Americans Use Technology for Healthcare,” sponsored by the Council of Accountable Physician Practices (CAPP) and the Bipartisan Policy Center, and presented at the “Better Together: High Tech and High Touch – The Patient-Physician Relationship in the New Millennium” event, held in Washington D.C., last November.

Highlights of this event are now available for viewing at bettertogetherhealth.org. CAPP’s Better Together Health event evolved from our desire to raise the voices of two key stakeholders who are often less prominent national discussions on the health care system– patients and physicians. This research, and our event, represented a major step forward toward fulfilling CAPP’s mission to advance the discussion toward truly accountable healthcare. While the media, healthcare marketers and technology companies hold up  technology as the solution to America’s healthcare problems, our 2015 survey results showed that most Americans don’t even get the “old school” phone and mail reminders about appointments. Only two percent have ever experienced a video doctor visit. Even people with complex or chronic illnesses didn’t have much access to the digital tools to help coordinate their care.

Our survey found that the reasons for this lack of access are complicated and multi-factorial. Despite the financial and regulatory barriers that exist to expand the use of telemedicine, the multi-specialty medical groups and integrated systems that are members of CAPP are leading the way — using their long-standing commitment to coordinated, patient-centered care to deliver solutions that are both high- tech and high-touch. Once again, You can see videos about how access to technology has transformed the lives of our patients here.

Meet Felipe, who lost his eyesight and now manages his diabetes through telehealth video consultations, saving him from the tremendous burden of traveling on public transportation across town to see a physician.

Watch Baby Emma recover at home from a burn wound while being monitored by video by her specialist.

Listen to Karen describe how her ten-year treatment for cancer is seamlessly coordinated through technology and her various careteams.

And to Teresa, who now enjoys her active senior lifestyle after a heart problem was resolved conveniently and safely through her tele-connected team of health specialists.

We hope our Better Together Health event  raised awareness of how the appropriate use of technology can improve patient care, reduce stress, and delivery quality outcomes.

This June, in 2016, we intend to continue the conversation as we ask what Americans really expect from their healthcare system.  To get more information about our upcoming events and activities, please visit www.bettertogetherhealth.org to sign up for updates.  We hope you will join us.

Why Do Docs Struggle to Coordinate Care? Blame the Lack of System Support

By Norman Chenven, M.D., CEO, Austin Regional Clinic
Vice-chair, Council of Accountable Physician Practices

A recent 10-nation Commonwealth Fund study of primary care physicians (PCPs) published in Health Affairs revealed that physicians surveyed struggled with care coordination, and that the U.S. has a higher percentage (about 25 percent) of primary care doctors who report that they are not prepared to care for patients with multiple chronic conditions. Additionally, 84 percent of American PCPs felt that they are not able to manage patients with severe mental illness or substance abuse.  As the CEO of a physician-led multispecialty medical group that is committed to and values good care coordination, I believe that the reasons that PCPs responded in this manner is because the majority of American physicians still work in organizations that do not provide them with adequate support.

Even though integrated systems and large multispecialty medical groups are increasingly investing in the infrastructure required to better coordinate care around patients with multiple and complex conditions, barriers created by our fragmented system of disconnected healthcare providers incentivized by a fee-for-service payment structure continue to hinder progress. The Affordable Care Act and the Centers for Medicare &
Medicaid Services have been implementing incremental changes (Accountable Care Organizations, Patient-Centered Medical Homes, Bundled Payments for Care Improvements, etc.) under the banner of value-based payment programs, which in theory could spur increased coordination. However, the underlying fee-for-service payment system used in many of these models does not adequately support or reward providers to invest in the technology and staffing necessary to manage the care of our frailest and sickest.

Evolving technologies could be used to enhance care coordination but the lack of incentives and rewards to do so is a problem. A recent study conducted by Nielsen Strategic Health Perspectives revealed that American physicians still do not utilize readily available technology—such as video, email or text messaging—to communicate with their patients and more than half are still skeptical of the value of telemedicine. We all intuitively understand that educational, social and financial issues are significant factors in influencing healthcare outcomes for patients for complex problems, yet our healthcare system does not encourage or support strong communication using existing technologies or integration with our equally fragmented social service system.

While those of us in the healthcare and social service sectors struggle to manage and coordinate the way we deliver care, tech innovators and venture capitalists are (not surprisingly) developing ways for consumers to get care outside of traditional channels (i.e., stand-alone urgent care centers, episodic online virtual visits, do-it-yourself lab testing, etc.).  While innovation is good, when it comes to health care, good outcomes for the larger system (and for patients with complex problems, in particular) are unlikely to be enhanced by further fragmentation of an already fragmented delivery system and payment mechanism.  Caring for patients with complex health and social needs requires more coordination and communication with providers who know the patient well.

The article further states that America’s efforts to manage the care of high-needs patients are “nascent.”  That may be true for doctors and facilities just starting their accountable care and medical home journeys. But, the members of the Council of Accountable Physician Practices and the American Medical Group Association have been delivering coordinated, accountable care for years.  Many of our physician-led, integrated, and technologically enabled organizations were the first to step forward to test new models of care and payment under the Affordable Care Act, yet improving care delivery under these new arrangements remains a complex endeavor even for us.

The U.S. is lagging in its ability to manage complex care for many reasons other than purely medical/technical ones, for we already have the training, medical technology and facilities that should support good outcomes. The challenge lies elsewhere in a multitude of legal, regulatory, financial and market barriers.

 

Majority of Americans don’t use digital technology to access doctors

Nielsen survey shows gaps in availability that must be fixed to improve patient care

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WASHINGTON, D.C. (November 04, 2015) – Today, Americans manage much of their lives through digital and electronic tools, except when it comes to healthcare. According to a new Nielsen survey released today by the Council of Accountable Physician Practices and the Bipartisan Policy Center, a majority of Americans are unaware of or don’t have access to the technology they could use to communicate with their doctors for better quality health care.

“Having ready access to a doctor is vital to high quality healthcare. Yet the busy schedules of consumers and physicians alike often prevent timely attention to routine and urgent healthcare problems in the traditional 9 to 5 physician office visit options. Digital technologies can help overcome the barriers to accessing medical care, yet our survey shows that these tools are not available to most Americans,” said Robert Pearl, M.D., Chairman of the Council of Accountable Physician Practices and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. “Healthcare providers must step up our adoption of these common-sense and available solutions if we are truly going to reform healthcare delivery.”

The survey, conducted by Nielsen Strategic Health Perspectives, polled more than 5,000 Americans ages 18 and over, and looked at attitudes about and use of technology to inform, access and manage their medical care.

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Results from those surveyed showed that:

  • Less than half – 45 percent – receive even the traditional telephone appointment reminders.
  • Only one in five – 21 percent – have access to online appointment scheduling with their doctors.
  • Fifteen percent use email to communicate with their provider.
  • Just 14 percent have 24/7 access to medical advice.
  • Fewer than one in ten – 9 percent – receive reminders by text.
  • Only a small percentage – 3 percent – are able to send a photo of a medical condition over email.
  • Just 2 percent have access to video visits.

The survey also highlighted four consumer groups who were most interested in gaining greater access to their doctors through digital and electronic technology: parents with children covered under their health plans, chronically ill patients, patients with acute conditions, and adults under 35 years of age.

The data also showed that consumers who don’t currently have access to their providers through electronic or digital communications are most interested in ready access and online interactions: 36 percent preferred traditional telephone-based medical advice, while 34 and 36 percent, respectively, expressed interest in one-way engagement such as online appointment scheduling and online portals to access test results.

“These findings emphasize how few patients and providers are actually using the technologies that we use in most other aspects of our daily lives,” said Janet Marchibroda, Director of Health Innovation at the Bipartisan Policy Center. “A lack of appropriate incentives as well as regulatory and legislative barriers have prevented many healthcare providers’ from implementing these technologies. Yet as healthcare organizations are increasingly responsible for improving the health of large populations, they must rely more on efficient, technology-driven patient-physician relationships to achieve performance goals. That means society must create incentives that facilitate adoption of these tools and technologies.”

Some technologies showed wider gaps between usage and interest than others among the people surveyed: 36 percent of adults were interested in a 24/7 telephone line for medical advice, yet only 14 percent had used such a tool; 28 percent were interested in text appointment reminders, yet only 9 percent had used them; and 26 percent were interested in submitting photos of conditions in preparation for phone or email consultations, yet only 3 percent had used such tools. Additionally, “virtual care” innovations, such as telemedicine, were found to be almost completely inaccessible to the average patient.

“Within these survey findings, it is important to note that the gaps between usage and interest levels may be an awareness issue. Consumers who expressed low interest levels in certain technologies may actually have limited awareness of available tools and the possible beneficial impact these applications may have,” noted Jennifer Colamonico, VP of Healthcare Insights and Chair at Strategic Health Perspectives, Nielsen Consumer Insights North America. “If consumers aren’t familiar with all the options, or cannot imagine how those options could enhance their healthcare experience, they place little value in such options. But consumer education can increase demand for and usage of these tools.”

Pearl concluded, “Our CAPP medical groups and health systems are committed to integrating the appropriate technologies to ensure that patients receive the high quality, coordinated and convenient care they deserve. The findings in this survey show that we all must ramp up our efforts to use technology to support the patient-doctor relationship and improve medical outcomes. Appropriate technology used in the context of accountable, coordinated care settings will improve access and produce better results. If we don’t take these steps, our efforts in population health management and in delivering accountable care will be seriously hampered.”

To see videos of real-life patients whose lives and health have been impacted by the appropriate use of healthcare technologies, click here.

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Welcome to the New Website and Blog for the Council of Accountable Physician Practices

By Robert Pearl, M.D.Chair, Council of Accountable Physician Practices

“Better Together” is a blog dedicated to sharing thoughts and ideas on how physicians can effectively lead the movement to improve the American healthcare system.  Through articles written by  by  CAPP medical group physician  leaders and others aligned with our mission,  this forum will inform and inspire physicians and healthcare leaders to improve the way we deliver care.

We all know about the gaps in our health care system that make receiving medical care difficult for many  patients, and keep physicians from communicating, coordinating and collaborating with each other to make the best, most timely care decisions. The twenty-eight multi-specialty medical groups and integrated health systems of CAPP are leaders and pioneers that strive to deliver a superior kind of health care – accountable, proactive,  physician led and patient focused. The result is increased preventive services, improved coordination and greater availability of advanced information  technology.

Through the “Better Together”  forum,  I believe that physicians can engage in discussions around ways to deliver and pay for medical care more effectively,  share best practices, propose innovative ideas and wrestle with the common challenges that practitioners and patients across this nation face.

A New Direction for CAPP

This website and the “Better Together”  blog represent a new direction for CAPP, one that seeks to find the signal through the noise, articulates the the benefits of integrated, organized systems of care in a way that we can all understand and helps other physicians embrace a more integrated practice structure.  CAPP has long been engaged in promoting new solutions for care delivery and in leading  the movement towards greater accountablity in healthcare. Our focus now expands to include educating American consumers, healthcare providers and payers about what accountable, coordinated  care actually looks like and the improved clinical outcomes it achieves.

Aligned with that goal, we have organized our first-ever major event to examine the model in greater detail, and allow participants to engage in a dialogue on this topic.

“Better Together – High Tech and High Touch: Patient-Physician Relationships in the New Millennium” will be held on Wednesday, November 4th, 2015, at the Center for Total Health in Washington, D.C.  The three-hour event, in partnership with The Bipartisan Policy Center (bipartisanpolicy.org), will bring together doctors, policy makers, patient advocates and patients to share real stories and the potential that the use of robust technology and video in accountable, coordinated systems can have.

Our members, and many of our colleagues in the healthcare world, continue to be troubled by a persistent knowledge gap and the seemingly low expectations surrounding the transformation of American medicine in the new era of “the consumer.”   In particular, we’re concerned that two important voices – the patient’s and the physician’s – are often conspicuously absent in the national dialogue on this critical subject. This and future events will  amplify those voices to achieve legislative and regulatory  reforms that support the patient-physician relationship.

We invite you to the live webcast of this event and to join the discussion. (For more information about the “Better Together” event, click here.)

Tell us, how do you think we could  be “Better Together” in healthcare delivery? We look forward to hearing your perspective.

 

North Shore-LIJ Makes Patient Satisfaction Scores Public

The North Shore-LIJ Medical Group, one of the nation’s largest multi-specialty group practices, and a member of the Council of Accountable Physician Practices, recently began posting online patient reviews of its doctors, the first large medical group in the New York metropolitan area to do so.

Consistent with its commitment to quality care and transparency, North Shore-LIJ Medical Group ratings are based upon actual surveys that are collected and monitored by a certified U.S. Centers for Medicare and Medicaid Services (CMS) vendor, Press Ganey.  This is in contrast to Yelp, Healthgrades and other physician rating sites that are open to anyone to rate a doctor, whether they saw the doctor or not.  North Shore-LIJ’s “Find a Doctor” profile pages provide consumers with feedback from actual patients on physicians practicing in one of the health system’s more than 400 Medical Group offices throughout the metropolitan area.  North Shore-LIJ’s Patient Satisfaction Review Program displays ratings and comments compiled from the more than 500,000 surveys randomly administered by Press Ganey, a South Bend, IN firm that works with more than 10,000 health care organizations worldwide.

“We are using transparency as an innovative approach to continuously improving as we strive to exceed our patients’ expectations,” said Ira Nash, MD, a practicing cardiologist and senior vice president and executive director of the North Shore-LIJ Medical Group, the nation’s seventh-largest physician practice. “This new site is truly the voice of the patients. It’s a trusted source of information on our doctors, as compared to comments and ratings on other physician review web sites that can’t be verified.”

Greater transparency is a cornerstone of recent healthcare legislation. North Shore-LIJ Medical Group is proud to be in the forefront as it makes individual physician reviews public, extending well beyond national mandates.

According to Press Ganey, the North Shore-LIJ Medical Group is one of a handful of large medical group practices in the US to post patient satisfaction scores and only the second in the Northeast.

While the North Shore-LIJ Medical Group includes more than 2,300 physicians, the ratings are available for the more than 900 doctors who provide care in ambulatory medical practice settings, mostly in outpatient offices outside the health system’s 19 hospitals. It does not include specialists such as radiologists, pathologists and other physicians such as neonatologists and hospitalists who provide patient care only in inpatient settings. The Medical Group has spent the past two years preparing for the public rollout of the new ratings site, working in collaboration with Press Ganey and physician leaders.

“We recognize that patients have many options for their care.  We also believe that a positive patient-physician dynamic is central to great care.  By being transparent with our patient satisfaction ratings, we are providing our patients with validated information that helps them choose the physicians that best meets their needs,” said Dr. Nash.

Also read Dr. Nash’s article on “Why Physicians Hate ‘Patient Satisfaction but Shouldn’t” in the September 8, 2015 edition of the Annals of Internal Medicine.

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Physician Leadership in Changing Times

In health care, as in life, change is the only constant. Today, the tides of change are pushing the health care system toward ever greater shared accountability among physicians, hospitals, and payers. Whether that change will ultimately benefit patients – or simply become an exercise in rearranging the deck chairs on the Titanic – will depend, in large part, on the skill of those who are leading the movement. As physician leaders of three of the nation׳s largest integrated health care delivery systems – Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System, respectively – we believe physicians must be central to this effort, in solid partnership with skilled administrators.

Among all providers, physicians have a disproportionate impact on the health care system and therefore have a disproportionate responsibility and opportunity to lead change. Patients experience their own health and the health care system in many ways: physically, socially, psychologically, and financially. As the first and primary point of contact with the health care system for most people, physicians must therefore act as caregivers, teachers, trusted information sources, and fiduciaries for their patients. They cannot and should not opt in and out of accountability toward their patients in any of these roles. In post-reform health care delivery systems, physicians are ideally positioned, and in fact compelled, to take responsibility for helping shape the health care system – not just their own practice – to better serve patients׳ physical, social, psychological, and financial needs. Many physicians in small, private practice are already experienced as civic and small-business leaders in their communities. However, the skills needed to run a small business and manage its resources are very different from those needed to lead delivery system change. This expanded paradigm of physician leadership cannot be accomplished working in isolation from the integrated systems of care, nor with indifference to the resources necessary to achieve good outcomes for entire populations.

We have a uniquely bright view of physicians׳ ability and willingness to take on this expanded leadership role. We also believe physicians can be led as trusted and respected members of a team that is greater than the sum of its parts. We call on physicians as a profession to view leadership – and the development of leaders – as key aspects of their role as advocate for their patients. In doing so, we draw on our 68 years of collective experience leading physicians into stable, respectful relationships with other delivery system stakeholders to support some of the most successful, patient-centered care systems in the nation.

Click here to read more about  “Why now, and why physicians?,” “What is a physician leader?,” and “Policy levers” in the full article by Drs. Jack Cochran, Gary S. Kaplan, and Robert E. Nesse in Healthcare: The Journal of Delivery Science and Innovation.

Learning from Medicare Advantage: Moving Toward a Better Model for American Health Care

By Robert Pearl, MD, CEO, The Permanente Medical Group
Chair, Council of Accountable Physician Practices

Despite the political angst, the doomsday predictions and a very rocky launch, the Affordable Care Act has enabled more than 8 million Americans to acquire insurance coverage through the public exchanges.

Health insurance increases the probability that patients will access the medical care they need. And my colleagues at Kaiser Permanente are already seeing some positive stories emerging as a result.

They’ve shared dozens of stories with me about patients with undiagnosed medical problems who are now receiving treatment. In particular, I enjoyed hearing about two new patients in Northern California who’ve benefited from being insured. They came in with life-threatening cancer: One, a mother with a uterine malignancy, and the other, a young man with a testicular mass. Both had gone years without medical care because they were unable to afford it. And now – thanks to medical coverage, early diagnosis and successful treatment – both will live.

But expanding access to health insurance is only the first step. Improving health care delivery is the next step in this journey.

With all the acrimony in our nation’s capital, bipartisan agreements are few and far between.

Medicare Advantage may be the one platform on which both parties can stand. Examining this program and why it has proven so successful offers us insights into where we as a nation might choose to go.

Medicare Advantage: A History Born from Necessity

Since the Medicare program was created in 1965, the federal government has been insuring citizens over the age of 65.This original form of Medicare, called traditional Medicare, was and remains a “fee-for-service” program. That means the Centers for Medicare and Medicaid Services (CMS) – the agency that administers the Medicare program – pays individual physicians for the services they provide to Medicare beneficiaries. Think of a service as an office visit, a test or a procedure. The price for those services is determined by the agency’s Physician Fee Schedule.

Beginning in 1978, Medicare beneficiaries had a second option. They could enroll in private Health Maintenance Organizations (HMOs) under a “risk contract” between CMS and the HMOs.

Over the next 25 years, many modifications to the original legislation were enacted by Congress. And in 2003, this program was renamed Medicare Advantage.

Unlike the government-run traditional Medicare option, the current Medicare Advantage program requires CMS to contract with private health plans on a prospective payment basis. These health plans then contract with individual medical groups and preferred provider networks to deliver the care that enrolled Medicare beneficiaries need.

Operating with a global budget and leveraging their capability to measure and report both quality performance and beneficiary satisfaction, Medicare Advantage plans have demonstrated increased care coordination and superior clinical outcomes.

As a result, these plans are becoming increasingly attractive to Medicare beneficiaries. In fact, 50 percent of new Medicare enrollees choose a Medicare Advantage option – enrollment in the program has tripled in a decade, and now exceeds 16 million beneficiaries. Some experts predict that Medicare Advantage enrollees will represent 30 percent of all Medicare beneficiaries by 2016.

Let’s explore three reasons why this program is so successful.

Reason 1: Beneficiaries Enjoy Abundant Choice and Predictable Costs

Medicare beneficiaries who select a Medicare Advantage plan obtain their care through dedicated delivery systems or provider networks.

In 2014, beneficiaries have an average of 18 Medicare Advantage options from which to select. And they can make their choice through the CMS website, which offers an online marketplace, including comparisons of quality and cost. According to recent Kaiser Family Foundation research, beneficiaries last year paid average monthly premiums of only $49 and most of these Medicare Advantage plans included Part D Drug coverage.

Unlike traditional Medicare, Medicare Advantage enrollees benefit from a limit on out-of-pocket costs. In 2014, the average out-of-pocket maximum for Medicare Advantage plans was $5,000. This gives enrollees – often living on fixed monthly incomes – more predictable costs and greater financial security.

Reason 2: Program Structure Provides Incentives for Superior Quality Outcomes and Service

The structure of Medicare Advantage creates incentives for providers to deliver comprehensive preventive services, achieve superior clinical quality and offer an excellent patient experience.

They know that satisfied beneficiaries will stay with the same plan and delivery system during the next annual selection process – with positive financial outcomes to boot.

And since government payments are based on the age of patients and the diseases they have — not the number of procedures performed — Medicare Advantage programs do best when the physicians and hospitals provide comprehensive preventive services, intervene early for patients with chronic illnesses, and avoid complications.

Although it’s difficult to compare overall outcomes, data from the National Committee for Quality Assurance (NCQA) show that Medicare Advantage organizations that score the highest tend to use a dedicated, integrated delivery system (including a multi-specialty medical group), and deploy a comprehensive electronic medical record (EMR).

Their results are in the top 10 percent of all programs in a broad set of areas, including managing blood pressure, reducing the risk factors that lead to heart attacks and strokes, and screening for cancer. In addition, their structure leads to more coordinated care, increased patient convenience, and greater access to technology, including both a comprehensive EMR and a variety of mobile device applications designed for ease of use by beneficiaries.

Reason 3: Five-Star Quality Rating System Holds Delivery Systems Accountable

An important feature of the Medicare Advantage program is the use of a Five-Star Quality Rating System.

Organizations participating in the Medicare Advantage program must report quality and patient satisfaction data to CMS on an annual basis. Based on this information, each Medicare Advantage program is awarded one to five stars. The Medicare stars program rewards the highest-rated organizations – the ones with superior quality and service results – with additional payments.

And with these dollars, they can invest further in the care of their members. Over time, this approach encourages every program to strive for higher quality and helps direct patients to those delivery systems that accomplish these goals. Most importantly, it results in patients obtaining even better medical care and more comprehensive preventive services.

Medicare Advantage Drawing Bipartisan Support, Sign of Program Success

For decades, liberal democrats have expressed antipathy toward the financing arrangements in Medicare Advantage. They’ve worried that this approach “privatizes” Medicare and allows insurance companies to benefit from this program by operating as “middlemen.”

But it is becoming clear is that the advantages of this program far outweigh the problems. By paying for value rather than volume – and by encouraging investments in superior quality, technology and coordination of care – the real winners are the Medicare beneficiaries and their health.

There’s increasing recognition across the country of our need to move from “fee-for-service” to “pay-for-value” payment models. And a growing number of democrats who were skeptical in the past are embracing this alternative to fee-for-service.

A recent bipartisan call to mitigate planned cuts in Medicare Advantage payments may be proof of this shifting perspective – whether or not those efforts are successful.

Learning from Medicare Advantage

A lot goes in to achieving superior performance, increased care coordination and improved quality outcomes.

For starters, care providers can’t allow patients to “fall through the cracks” when they receive treatment from multiple doctors or in multiple venues. Achieving this increased degree of safety requires a dedicated delivery system committed to seamlessly transitioning patients and their medical information from one provider or venue to the next.

It also requires the deployment and “meaningful use” of a comprehensive electronic medical record (EMR) that provides vital information at every point of contact. Having this information rapid treatment and allows gaps in prevention to be addressed immediately and by all physicians involved in the patient’s care.

And prospective payment creates incentives to provide appropriate preventive services, minimize complications and ensure patients recover as soon as possible.

The Medicare Advantage program offers a model for broader delivery system reform as we continue the journey from a fee-for-service/pay-for-volume “sick care” system to a pay-for-value/health-promoting approach.

Accountable Care Organizations – structured along the same principles of prepayment, prevention, care coordination, integration between primary and specialty care, and a commitment to measuring and improving performance – have the potential to move the country forward on the path to true health care reform. And other models are likely to be developed in the future.

We’ve expanded health insurance coverage for Americans in a year and improved health care for millions. Now, it’s time to focus on improving the process of care delivery in America.

Medicare Advantage doesn’t solve all of today’s health care challenges, but it is a good start. And we can learn a lot from its success.

Reprinted with permission from Forbes.com.