Paths to Sustainability for Innovative Delivery System Programs.

Area of Science:

• Health Services Research
• Healthcare Management
• Health Economics

Background:

• Innovative healthcare delivery models aim to enhance quality and reduce acute care utilization and costs.
• Sustainability of these novel programs remains a critical concern for healthcare organizations.

Purpose of the Study:

• To identify pathways to sustainability for innovative care delivery programs.
• To examine reimbursement methods, eligibility criteria, and investment strategies for new care models.

Main Methods:

• Analysis of health plans and Accountable Care Organizations (ACOs) in Massachusetts.
• Investigation of reimbursement approaches for new care delivery models.
• Examination of criteria for health plan eligibility and ACO investment in delivery innovations.

Main Results:

• A high degree of interest exists, but the environment for sustaining care delivery innovations is highly uncertain.
• Innovation is likely to be concentrated in systems capable of managing financial risk and possessing delivery innovation capacity.
• Providers face challenges in building capacity for financial risk management and care improvement, particularly smaller organizations.

Conclusions:

• The sustainability of innovative care delivery hinges on financial risk management and organizational capacity.
• Payers should support smaller, less-experienced providers to foster innovation and improve care delivery.
• Targeted support from payers can enable broader participation in healthcare innovation.