The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
We focus on a number of topic areas identified by state health policy leaders as important to population health.
The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
Keep up with news and updates from the Milbank Memorial Fund. Get the latest from thought leaders, including Christopher F. Koller, president of the Fund.
We publish The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to population health.
Debra Hurwitz and Pano Yeracaris from the Care Transformation Collaborative of Rhode Island (CTC-RI) describe their recently concluded three-year pilot program focused on integrating behavioral health in primary care practices. The model includes universal screening for depression, anxiety, and substance use disorder; a team member who is an onsite behavioral health clinician; and monthly team meetings with a clinical psychologist. This presentation walks through the qualitative study that shows a high degree of acceptance/satisfaction by primary care providers and improvements in patient outcomes. The RI all-payer claims database shows lower inpatient and emergency department utilization, and a lower total cost of care than in a comparison group.
See the presentation here.
Psychiatrist and advocate Henry Harbin, and health economist Michael Schoenbaum of the National Institute of Mental Health, discuss the efficacy and centrality of behavioral health access, tracking, and measurement in the CPC+. Mental illness and substance use are major drivers of disability and costs. Effective treatments exist, but currently there are not enough specialty providers to provide the necessary care. By effectively integrating behavioral health care with primary care we can increase access to care, improve health outcomes, and lower costs.
See presentation slides here.
See Medicare Learning Network Fact Sheet here.
See New England Journal of Medicine article here.
See The Kennedy Forum article here.
See the Collaborative Care Model here.
Richard F. Shonk, MD, PhD, of The Health Collaborative, shares the results of the extensive analysis of member outcomes from CPC Classic. In contrast to the minimal impacts observed in Medicare fee-for-service beneficiaries, Dr. Shonk’s presentation describes the substantial increases in utilization, cost decreases in the participating Ohio payers’ commercial and Medicare Advantage populations, and the importance of looking at results across payer types when evaluating outcomes. Dr. Shonk and Dr. Laura Sessums recently published their findings in a Health Affairs Blog post, The Comprehensive Primary Care Initiative: Another Side of the Story. This post provides their perspectives as physicians active in primary care transformation and offers insights gleaned in discussions with private payers and physicians who participated in CPC.
See the presentation slides here.
Guest speaker Craig Jones, MD, formerly the director of the Vermont Blueprint for Health, and now an independent consultant for Deloitte as well as with the Office of the National Coordinator at the U.S. Department of Health and Human Services is doing technical and cultural assessments of CPC+ regions’ information technology capacity, and has found some compelling and informative patterns. He shared the important results of his multiple site visits and interviews.
See the discussion topics here.
Dr. Johnson, Vice President for Enterprise Data & Analytics Blue Cross Blue Shield of Kansas City, presented a summary of her study on the BCBS Kansas City Medical Home Program. Her study, which is the basis of her doctoral dissertation, examines three important questions: 1) How do basic characteristics of medical homes and non-medical homes differ? 2) Does medical home implementation influence physician practice patterns? 3) Does medical home ownership influence total cost of care or utilization rates for high-cost services? Dr. Johnson and participants in the webinar discuss the implications this study has for building a strong primary care foundation and the potential roles that payers have in enhancing financial incentives, reducing administrative burdens, implementing benefit design that promote primary care, and focusing on accountable care agreements that move beyond primary care.
The results of the most recent CPC+ Market Update Tool indicate several payer milestones that are proving to be challenging to achieve, notably in data aggregation and in Track 2 payment. We heard about strategies being used and progress being made in these areas in two CPC+ regions.
The CMS Innovation Center (CMMI) released a Request for Information (RFI), seeking input on the concept of Direct Provider Contracting (DPC). The public comment period for this is quite brief, ending on May 25, 2018. This presents us with a critical and time-sensitive opportunity to inform the future focus of CMMI by sharing your organizations’ and personal opinions.
Several colleagues generously offered to share their experience and opinions about DPC in a panel presentation set up by the Fund, to be followed by an facilitated question and answer session.
Rachel Block, Milbank Memorial Fund Program Officer, and report co-author Mark Friedberg of the Rand Corporation will discuss the methods and findings of a study, published in 2017 by the Fund, on Standardizing the Measurement of Commercial Health Plan Primary Care Spending.
Our colleagues from Blue Cross and Blue Shield of Kansas City, Qiana Thomason, Vice President for Population Health Solutions, and Karen Johnson, Vice President for Healthcare Insights & Partnerships, share their experiences bringing their administrative services only lines of business into the CPC+ effort.
UAMS faculty members Wendy Ward, Stephanie Gardner, Mark Jansen, and Kathryn Neill describe their groundbreaking innovative curriculum and its implementation.
See the presentation slides.
Click here and here for additional resources.
The Multi-State Collaborative hosted a webinar featuring Diane Bechel-Marriott, DrPH, CPC+ Michigan Convener and Manager of Multipayer Initiatives at the University of Michigan, and Ann Greiner, President and CEO of the Patient-Centered Primary Care Collaborative. They discussed the role of patient and caregiver engagement in transforming primary care. Patient and caregiver engagement represents one of the five functions of CPC+. The others are access and continuity, care management, planned care and population health, and comprehensiveness and coordination.
Both Greiner and Bechel-Marriot explain how patients can become involved in practice design that leads to care that is more responsive to patient needs. They also highlight patient and clinician education as an important first step. While patient and caregiver engagement is only one of the five CPC Plus function domains, Bechel-Marriot notes its potential for benefiting the other four.
Go to the PCPCC’s TCPI resource page, which provides free tools for practice transformation coaches and practices related to patient and family engagement. See Bechel-Marriot’s presentation slides here.
The Multi-State Collaborative (MC) hosted a webinar featuring researchers from Mathematica Policy Research. Erin Taylor, director of health research, Grace Anglin, researcher, and Debbie Peikes, senior fellow, discussed findings from the third annual evaluation report on the Comprehensive Primary Care (CPC) initiative, which ended in December 2016. They shared information about multi-payer collaboration and how payers can come together to support best practices in improving patient care. The presenters also discussed lessons learned that could be applied to the Comprehensive Primary Care Plus (CPC+) initiative, which started its first of five years in January 2017.
(The webinar begins at the 2:50 mark; it is sound only.)
The webinar focuses on some of the challenges faced by CPC regions: aligning quality measures across payers (given that different payers may serve different enrolled populations); overcoming the unanticipated complexity of the process of payer data aggregation; and engaging self-insured payers in the region in transforming care delivery.
The speakers highlighted several lessons from CPC that payers may apply to CPC+ or other multi-payer initiatives:
Read CPC’s third annual evaluation report.
The Multi-State Collaborative (MC) hosted a webinar on data aggregation, analytics and reporting in multi-payer environments. David Jorgenson and Melanie Pinette of Onpoint Health Data shared their experiences developing and building data integration, analytics, and reporting systems in the Multi-Payer Advanced Primary Care Practice (MAPCP) demonstrations in Vermont and Rhode Island. The presentations were followed by a Q&A session facilitated by Lisa Dulsky Watkins, MC Director. Read an additional resource with background information from the webinar presenters.