CAPP pursues the goal of elevating the high-quality, high-value health care our organizations provide through our research and communications activities, which have resulted in these following research and publications:
- “Physician Leadership in Changing Times” (Healthcare: The Journal of Delivery Science and Innovation, 2014)Based on the research conducted by CAPP in 2012, CAPP physician leaders authored a series of five articles to describe how leadership training occurs in their organizations, the structure of these programs, and lessons learned. The first publication–a call to action entitled “Physician Leadership in Changing Times” (Cochran, Jack, Gary S. Kaplan and Robert E. Nesse) was published in Healthcare: The Journal of Delivery Science and Innovation, 2014. The additional topics covered in the subsequent articles are:
- Recruitment and Retention of Physician Leaders
- Training Physician Leaders
- Physician Leadership in Organizations Undergoing Major Transformation
- Physician Leadership Initiatives at Small or Mid-Size Organizations
These articles will be published as a series in late 2015 in Healthcare: The Journal of Delivery Science and Innovation.
- “Many Large Medical Groups Will Need to Acquire New Skills and Tools to Be Ready for Payment Reform” (Health Affairs, 2012).
This project, led by researchers Robert Mechanic and Darren Zinner, defines the prevalence and magnitude of bundled payments, capitation and other models that shift incentives from volume to value-based measurement. Twenty CAPP groups participated in a survey about their payment practices. Early rounds of this survey found fee-for-service to be the dominant payment method. A third survey round will be conducted in late 2015. Resulting publication: “Many Large Medical Groups Will Need to Acquire New Skills and Tools to Be Ready for Payment Reform” (Health Affairs, 2012). Additional publications to report on the ongoing results are expected.
- “Delivery System Reform Tracking: A Framework for Understanding Change,” (Commonwealth Fund Issue Brief, June, 2011)
This was a joint project of CAPP, The Commonwealth Fund, Kaiser Permanente Institute for Health Policy, and Alain Enthoven, PhD, of Stanford to develop a mechanism to understand and measure the evolution of delivery system reform across the nation. Resulting publication: “Delivery System Reform Tracking: A Framework for Understanding Change,” published by the Commonwealth Fund as an issue brief in June 2011.
- “Higher Health Care Quality And Bigger Savings Found At Large Multispecialty Medical Groups” (Health Affairs, May, 2010)
In 2006, CAPP launched a study to analyze linked data from (1) CAPP multi-specialty group practices; (2) Medicare claims from Dartmouth’s Medicare fee-for-service claims database; and (3) National Survey of Physician Organizations (NSPO) NSPO1 and NSPO2 data on organizational attributes and care management processes at these organizations. The study provides insight into differences in performance across these organizations and the association between better performance and the presence of specific organizational attributes and specific care management processes. The research was led by Elliott Fisher, MD, of the Dartmouth Center for Evaluative Clinical Sciences; Larry Casalino, MD, of Weill Cornell Medical College and New York-Presbyterian Hospital; and Stephen Shortell, PhD, of University of California, Berkeley. Resulting publication: “Higher Health Care Quality And Bigger Savings Found At Large Multispecialty Medical Groups,” May, 2010 in Health Affairs.
- Partners in Health: How Physicians and Hospitals can be Accountable Together, ( Jossey-Bass, April, 2010)
The concept of “accountable care organizations” has gained traction with the current health insurance reform debate, and there is increasing acceptance among industry leaders that care coordination that comes from system integration is necessary to achieve both the cost and quality goals of health reform. CAPP with the Kaiser Permanente Institute of Health Policy identified expert authors to collaborate on a book about physician-hospital integration. Resulting publication: The book, Partners in Health: How Physicians and Hospitals can be Accountable Together, authored by Dr. Jay Crossen and Laura Tollen, was published by Jossey-Bass (Wiley) in April 2010. This publication was featured in Accountable Care News, CAPG Health, and Modern Healthcare.
- “Meaningful Variation in Performance: What Does Variation in Quality Tell Us About Improving Quality?” (Medical Care, February, 2010)
The current practice of reporting at the individual physician level in “transparency” initiatives doesn’t capture the value of care coordination, and encounters problems due to small sample sizes and difficulties in determining accountability for care when multiple providers deliver services. CAPP embarked on research to better understand the impact of reporting levels on sample size needs, the number of available measures, and attribution methods. Resulting publication: This research has been published as “Meaningful Variation in Performance: What Does Variation in Quality Tell Us About Improving Quality?” in Medical Care, February, 2010.
- “How Can Medicare Lead Delivery System Reform?” (Commonwealth Fund Issue Brief, November 13, 2009)
On June 5, 2009, CAPP, The Commonwealth Fund, and Kaiser Permanente Institute for Health Policy hosted a roundtable discussion on payment and delivery system reform in Washington, D.C. Attendees of the roundtable included many leaders of CAPP’s multispecialty medical groups and health systems; renowned academics and health care researchers; and private and government policy and health industry leaders. Resulting publication: A subsequent paper evolved from the meeting titled “How Can Medicare Lead Delivery System Reform?” and was published as a Commonwealth Fund Issue Brief on November 13, 2009. - “Is Integration in Large Medical Groups Associated with Quality?” (The American Journal of Managed Care, June, 2009)
In 2006, the CAPP Advisory Council recommended that CAPP collect best practices in (1) the use of IT and the EMR in the care of chronic conditions; (2) capabilities to provide feedback and guidance on the overall performance of a practice and its physicians; and (3) capabilities to provide patient-centered care. The study summarizes the current capabilities across the CAPP groups and examines the relationship between the degree of integration and use of care management processes. Resulting publication: The paper was published by The American Journal of Managed Care in June, 2009, under the title “Is Integration in Large Medical Groups Associated with Quality?” - “From Our Lips To Whose Ears? Consumer Reaction to Our Current Health Care Dialect” (The Permanente Journal, January, 2009)
In 2008, CAPP completed a series of consumer focus groups to test marketing language and strategies promoting coordinated care. In 2009, we sought to further understand consumer attitudes about the kind of care they can receive in a “coordinated care” multispecialty group or organized health care system. With the support of the Kaiser Permanente Institute for Health Policy, CAPP conducted another series of eight national focus groups to determine consumer understanding of the difference between fragmented care and coordinated care, assess consumer acceptance of coordinated care, and explore the willingness of consumers to make tradeoffs in a transition to coordinated care. Resulting publication: The results of these focus groups were published in the January 2009 issue of The Permanente Journal as “From Our Lips To Whose Ears? Consumer Reaction to Our Current Health Care Dialect” and a subsequent marketing-focused article “When We Speak, What Do They Hear?” was published in the February 2009 issue of AMGA’s Group Practice Journal.
Other notable research and publications:
Physicians Foundation IDS/IPA Research: CAPP received a grant from the Physician Foundation to produce case examples of successful physician-led integrated independent practice associations (IPA), to better understand the steps followed in creating these organizations and lessons learned. Resulting publication: Expected in late 2015
Physician-Hospital Integration: As physician-hospital relationships remain a significant factor in the success of the accountable care movement, CAPP sought to explore successful models of collaboration/partnerships between physicians and hospitals, specifically addressing the potential consequence of hospital revenue loss resulting from implementation of ACOs. Throughout 2012, CAPP conducted interviews with over 20 thought leaders and relevant experts on the topic.
Transitioning to Accountable Care — Implications for Healthcare Communicators: In 2012, CAPP sought to better understand how medical groups and hospitals perceive the role of communications in ACO development and implementation. Sponsored by Maricich Healthcare and in partnership with the American Hospital Association, CAPP conducted an online survey with the members of the American Medical Group Association (representing physician groups) and of the Society of Healthcare Strategy & Market Development (representing hospital organizations) to answer key questions. Resulting publication: The combined CAPP report was disseminated in December 2012 and is available at http://www.maricich.com/aco