Milbank-Supported Report on the Patient-Centered Medical Home’s Impact on Cost and Quality
January 14, 2014
A new analysis released today by the Patient-Centered Primary Care Collaborative with support from the Milbank Memorial Fund reports on an expanding body of research that shows that the patient-centered medical home (PCMH) model is having a significant impact on reducing costs of care and unnecessary emergency department (ED) and hospital visits, as well as increasing the provision of preventive services and improving population health.
The report, The Patient-Centered Medical Home's Impact on Cost & Quality: An Annual Update of the Evidence, 2012–2013, analyzed quantitative outcomes across twenty medical home evaluations from August 2012–2013, including thirteen peer-review and seven industry-generated evaluations. It reports on evaluations from a broad range of stakeholders and identifies the results by four outcome measure categories: cost and utilization, population health and prevention, access to care, and patient or clinician satisfaction.
These studies documented the following areas of improved performance resulting from PCMH implementation: reduction in the use of unnecessary or avoidable services, decrease in the cost of care, improvement in population health indicators, increase in preventive services, improvement in access to care, and improvement in patient satisfaction. The authors also call for more robust analyses regarding how PCMH's function, transform, and improve outcomes for all patients and their families.
The report emphasizes that as private and public sector support for the PCMH continues to build, those developing the PCMH model need to learn from the expanding evidence and experience base, and develop a clear, foundational role of the PCMH in Accountable Care Organization and medical neighborhood models, as well as in payment reform efforts that reward quality and value.
The Milbank Memorial Fund provided financial and editorial assistance for the report. "There is strong evidence, much of it published in The Milbank Quarterly, that an abundance of high quality primary care is essential to improving the health of populations," said Christopher Koller, President of the Fund. "It is not a question of whether to invest in more primary care, but how. This report is part of the Fund's broader commitment to help build high quality primary care to improve population health. It is our hope that it will serve as a resource for all health care leaders to learn how the PCMH is improving the health care system at the patient and provider level, the practice level, and the health system level, and to provide an agenda for further improvement."
Click here to download the report.
November 14, 2013
The Milbank Memorial Fund has announced additions to its Board of Directors and management team.
At its October 15, 2013 meeting, the Board of Directors of the Milbank Memorial Fund elected Paul D. Cleary and John M. Colmers to serve as new directors of the organization.
Dr. Cleary is dean of the Yale School of Public Health and the Anna M.R. Lauder Professor of Public Health at the Yale University School of Medicine. Besides his administrative responsibilities, he has studied how organizational characteristics affect the costs and quality of care for persons with AIDS, evaluated a national continuous quality improvement initiative in clinics providing care to HIV-infected individuals, and studied the long-term impact of patient-centered hospital care. A member of the Institute of Medicine since 1994, Dr. Cleary was editor of The Milbank Quarterly from 1992 to 2000. He is chair of the National Advisory Committee for the Robert Wood Johnson Foundation Investigator Awards in Health Policy Research program.
Mr. Colmers is vice president of health care transformation and strategic planning for Johns Hopkins Medicine. He also serves as chair of the Maryland Health Services Cost Review Commission. From January 2007 to January 2011 he served as secretary of the Maryland Department of Health and Mental Hygiene and from November 2000 to January 2007 was a senior program officer here at the Fund. Prior to joining the Fund, he spent nineteen years in Maryland state government where he held various positions, including executive director of the Maryland Health Care Commission and the Health Services Cost Review Commission.
"We are honored and fortunate to have Dr. Cleary and Mr. Colmers join the Board," said Board Chair Samuel L. (Tony) Milbank. "Both are distinguished professionals in precisely the areas where we work—identifying the best evidence and experience to help decision makers improve the health of populations. Both have extensive governance experience; their presence will help our deliberations immensely."
Christopher F. Koller, president of the Fund, also announced the appointment of Trina A. Gonzalez as program officer of the Fund. Ms. Gonzalez comes to this role after sixteen years in public service in California state government, most recently as interim chief of the Center for Innovation at the California Public Employees Retirement System. Last year, she left public service to obtain a master's degree in public policy from the Woodrow Wilson School of Public and International Affairs at Princeton University. "Trina is a great fit for our work," said Mr. Koller. "As program officer she will have primary responsibility for the Reforming States Group (RSG), our flagship programmatic initiative. Her deep experience of working with executive and legislative branch state officials to implement meaningful policies places the RSG and other Fund work in good hands."
November 7, 2013
A new case study released by Catalyst for Payment Reform (CPR) with support from the Milbank Memorial Fund shares the story of South Carolina's Birth Outcomes Initiative (BOI).
The case study, Using Education, Collaboration, and Payment Reform to Reduce Early Elective Deliveries, chronicles how South Carolina's Department of Health and Human Services, South Carolina's largest commercial health plan, and many other stakeholders partnered to engage providers in quality improvement activities, and then agreed together to stop paying for early elective deliveries—those occurring before 39 weeks gestation. Early elective deliveries are associated with worse health outcomes for infants and mothers and higher health care costs. Despite the overwhelming evidence against early elective deliveries, an estimated 10 to 15 percent of babies in the United States continue to be delivered early without medical cause.
The South Carolina BOI has so far reduced unwarranted early elective inductions by 50 percent, decreased neonatal intensive care unit admissions, and saved the State's Department of Health and Human Services more than $6 million (in just the first quarter of 2013). South Carolina is the first state in the nation in which the Medicaid agency and the largest commercial insurer have collaborated to establish a policy of nonpayment for early elective deliveries.
The Milbank Memorial Fund provided financial and editorial assistance for the project. "There is an enormous benefit-to-cost ratio from implementing policies that reduce early births; but that implementation is challenging," said Christopher Koller, president of the Milbank Memorial Fund. "This report details the importance of leadership, evidence and collaboration and provides valuable lessons for state policy makers and private sector purchasers. We are eager to share it with our stakeholders and appreciate the collaboration with CPR." To download the case study, click here.
Lead Wars Mentioned in New York Times Op-ed
October 23, 2013
The most recent book published in the California/Milbank Books on Health and the Public series, Lead Wars by Gerald Markowitz and David Rosner, was mentioned in a recent New York Times op-ed by Nicholas D. Kristof on the threat of lead and other toxins to the health of humans. To access the article, click here.
Tribute to Bradford H. Gray, Outgoing Editor of The Milbank Quarterly
October 3, 2013
With the December issue of The Milbank Quarterly, now in its final touches, and the arrival of October first, we come to the final chapter of the distinguished service of Bradford H. Gray as Editor of The Milbank Quarterly. On behalf of the Board and staff of the Milbank Memorial Fund, the Members of the Quarterly’s Editorial Board, and all the readers and authors who have been enriched by the work of the Quarterly, I would like to commend Brad and express our gratitude for both his hard work and the high standards he has set for the Quarterly.
His successor, Howard Markel, inherits a strong publication, thanks to Brad. From the third issue of 2000 to the fourth issue of 2013, Brad managed and advanced a journal that has had a distinguished history since its inception in 1923. In the thirteen years that he was editor of the Quarterly, Brad reviewed more than 1,900 manuscripts with the help of more than 2,500 reviewers. His reputation for highly regarded scholarship and his strong editorial skills enabled him to expand the reach of the Quarterly to attract new authors. One of Brad’s editorial hallmarks was the care he took during the editorial review process – extending to comprehensive and thoughtful comments back to prospective authors. Not coincidentally, the number of submissions per year more than doubled under his editorship, and there was an increase in the number of submissions from authors outside the United States.
The Quarterly continued to be highly cited under Brad’s editorial leadership, consistently ranking in the top six journals in the categories of “Health Care Sciences and Services” and “Health Policy and Services,” and ranking first in those categories for the past three years. The number of citations to all Quarterly articles per year increased more than seventy-five percent since 2000. The Quarterly also continued to publish articles that remain topical long after their publication date, as evidenced by the ongoing demand for older articles – a tribute to Brad’s strong editorial judgment.
Brad, in addition to his editorial responsibilities, has been a senior fellow at the Urban Institute’s Health Policy Center. Prior to joining the Urban Institute in 2004, he held senior policy research positions at the New York Academy of Medicine, Yale University, and the Institute of Medicine. He has written extensively about for-profit and nonprofit health care and has also published research on Medicaid, managed care, ethical issues in research, and the politics of health services research. Brad holds a PhD in sociology from Yale University. He is a fellow of the Hastings Center and AcademyHealth, and is a member of the Institute of Medicine of the National Academy of Sciences.
As he transitions to his next, well-earned, much-postponed and hopefully more leisurely stage of a distinguished professional career, it is important to express our appreciation for the diligence, good humor, intellectual curiosity and collegiality that have marked Brad’s tenure at the Quarterly. He has built a legacy that has greatly enriched and strengthened the efforts of all of us who work to bring thoughtful, credible evidence to the task of improving the health of populations.
Christopher F. Koller
President, Milbank Memorial Fund
Publisher, The Milbank Quarterly
Commentary on the Affordable Care Act by Christopher Koller
October 1, 2013
Christopher Koller, president of the Milbank Memorial Fund, discusses the potential impact of the Affordable Care Act on the lives of Americans and the health care system at large in his commentary “What Obamacare Does and Doesn’t Mean,” published by Brown University. To access the article, click here.
New Book from a Partner Organization
September 18, 2013
The Milbank Memorial Fund announces the publication of Transforming the Global Health Workforce. Published by NYU College of Nursing, the book addresses key issues that countries face today in building, retaining, and deploying a competent and skilled health care workforce in an increasingly globalized environment. Edited by Marilyn A. DeLuca and Agnes Soucat, the book includes papers written by experts in the field and was inspired by the Global Summit, Strengthening 21st Century Global Health Systems: Investing Strategically in the Health Care Workforce, which was held in October 2011 at NYU. The Milbank Memorial Fund was a partner of the summit and provided support for the publication of the book. An electronic version of the book is available at https://archive.nyu.edu/handle/2451/31736 and a print version is available at http://bookstores.nyu.edu/main.store.
Early View of an Article from The Milbank Quarterly
July 23, 2013
The Milbank Memorial Fund is pleased to announce the early online publication of an article from the forthcoming issue of The Milbank Quarterly: “Shifting the Paradigm: Using HIV Surveillance Data as a Foundation for Improving HIV Care and Preventing HIV Infection” by Patricia Sweeney and colleagues. The authors, most of whom are with the HIV-AIDS prevention program at the Centers for Disease Control and Prevention (CDC), discuss how ethical and policy considerations regarding the use of HIV surveillance data are being changed by progress in the treatment and prevention of HIV/AIDS. Health care providers and laboratories have long been required to report positive HIV test results for public health surveillance purposes, but the uses of that information have been quite limited for privacy reasons and concerns about reducing people's willingness to be tested. However, many people who test positive are not getting treatment. Surveillance data could be linked with treatment data to identify and facilitate contact with such people to encourage them to enter treatment. The “paradigm shift” of the article's title is the move from using HIV-status information only for traditional public health surveillance purposes (i.e., to track the spread of the disease) to using it to improve the care of HIV-infected individuals. To access the article, please click here.
Mark T. Benton Appointed Chief of Staff at Community Care of North Carolina
July 16, 2013
Mark T. Benton, former senior program officer of the Fund, is now chief of staff for Community Care of North Carolina, a nonprofit organization that provides care coordination and population health management to the state's Medicaid recipients and other insured and uninsured residents. He began his new position on July 1. Mr. Benton joined the Fund in 2007 after serving as North Carolina's Medicaid director. During his tenure with the Fund, he worked closely with the Reforming States Group and led successful projects addressing Medicaid managed care, health systems reform, and data sharing. At the announcement of his departure, immediate past president Carmen Hooker Odom said, "Mark was an outstanding senior program officer for the Fund. He combined his experience in state government with a deep appreciation of the perspectives of policymakers. He was very successful in carrying out the mission of the Fund, which is to assist policymakers to use the best available evidence in decision making."
Bishop Joseph M. Sullivan, 1930–2013
June 12, 2013
The Board of Directors and staff of the Milbank Memorial Fund mourn the passing of our beloved colleague, Bishop Joseph M. Sullivan, on June 7, 2013. He lived his profound commitment to the overwhelming importance of preventing and ameliorating suffering. As a Director of the Fund for the past fifteen years, Bishop Sullivan has been an exemplar, a mentor, and a friend. He brought wisdom and compassion to our work of helping to apply the best available evidence to policy and practice for maintaining and improving health. Bishop Sullivan contributed enormously to human betterment in the city, the state, and the nation. He blended spirituality with commitment to people and institutions; and did it with wit, charm, analytical precision, and—when persuaded to use it—a beautiful singing voice.
Milbank Memorial Fund Announces New Editor-in-Chief of The Milbank Quarterly
May 22, 2013
Howard Markel, M.D., Ph.D., will become Editor-in-Chief of The Milbank Quarterly on October 1, 2013, succeeding Bradford H. Gray, Ph.D., Editor since 2000. Announcing this appointment, Christopher F. Koller, who becomes President of the Milbank Memorial Fund on July 15, said that Dr. Markel is "superbly qualified to maintain and enhance the Quarterly's role as a leading international journal of health care policy and population health."
Dr. Markel will continue his current work as a professor, researcher, author, educator, and public health policy advisor. He serves as the George E. Wantz Distinguished Professor of the History of Medicine and Director of the Center for the History of Medicine at the University of Michigan, where he also holds professorial appointments in psychiatry, public health, history, English literature and language, and pediatrics and communicable diseases.
A critically acclaimed historian of medicine, he has written more than 350 articles in peer-reviewed journals and the popular press. He is a frequent contributor to The New York Times, National Public Radio, and PBS NewsHour, and is also the author or editor of ten books. His most recent volume is the national best-seller An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug, Cocaine (Pantheon/Alfred Knopf Books, 2011), which was reviewed on the front page of The New York Times Book Review and described as "a tour-de-force of scientific and social history." An internationally known authority on the social history of epidemics and quarantine, Dr. Markel leads a research team at the University of Michigan investigating the effectiveness of public health interventions during influenza pandemics from 1918 to the present. As a result of this work, he advises the U.S. Centers for Disease Control and Prevention on policy for preventing and containing current outbreaks of that disease. Dr. Markel was elected to the Institute of Medicine of the National Academy of Sciences in 2008.
"I am deeply honored to be chosen to edit the Quarterly, a journal of distinction and excellence since its founding in 1923. With the growth of medical care expenses and the ongoing challenges to the health of populations and communities, the need for thought-provoking, peer-reviewed, and socially relevant interdisciplinary research and writing in the health services field will only grow in the coming years. The Quarterly will be one of the key places to find such critical information for health care policymakers and scholars as well as population health practitioners," Dr. Markel said. Noting that President Koller has also asked him to advise about other publications of the Fund, he added, "I look forward to the challenge of using electronic and print media to expand the audiences for the achievements of this great foundation and the stellar work of our colleagues and contributors."
Milbank Memorial Fund Announces New President
April 18, 2013
The Board of Directors of the Milbank Memorial Fund is pleased to announce it has selected Christopher F. Koller to become the next President of the Fund. He will succeed Carmen Hooker Odom, starting July 15, 2013. Mr. Koller, currently Health Insurance Commissioner for the State of Rhode Island, is a nationally recognized leader in state health policy, Medicaid managed care, and health plan regulatory development. His experience with the Fund includes participation in the Fund’s Reforming States Group and founding membership in the Multi-State Learning Health System Collaborative.
“For over one hundred years, the Milbank Memorial Fund has been on the forefront of linking theory and practice to improve the health of populations,” said Board Chairman Samuel L. (Tony) Milbank. “As the U.S. grapples with health care challenges, including rising costs, rising obesity rates, and implementing the Affordable Care Act, the Fund is committed to disseminating research and convening leaders to address these challenges. In Mr. Koller, we have found someone to lead this effort.”
Mr. Koller was appointed the first health insurance commissioner in the country in 2005. In that role, he developed comprehensive commercial health insurance oversight strategies, led statewide insurance affordability efforts—particularly in all-payer payment reform and primary care practice revitalization—and helped Rhode Island implement the Affordable Care Act. He has served on the Institute of Medicine’s Essential Health Benefits Commission, the Executive Committee of the National Academy for State Health Policy, various committees for the National Association of Insurance Commissioners, and numerous national panels. Previously, he was CEO of the Neighborhood Health Plan of Rhode Island, achieving a ranking of first among Medicaid HMOs by U.S. News and World Report. He holds a bachelor’s degree in economics and math from Dartmouth College, a master’s degree in public and private management from Yale University, and a master’s degree in religion, concentrating on social ethics, from Yale Divinity School.
“I am grateful to the Board of the Fund for extending to me this opportunity,” said Mr. Koller. “I look forward to working with the Fund’s many collaborators to build on its strong tradition of communicating high-quality interdisciplinary research on critical issues affecting the health of populations and linking it to effective practices through networks of policymakers.”