Duke-Margolis Launches Initiative to Improve Health Care for Serious Illness

The Duke-Margolis Center for Health Policy, funded by the Gordon and Betty Moore Foundation, is launching an initiative to investigate how accountable care approaches can improve care for people with serious illnesses, which is a next step in the Center’s work on accountable care. In partnership with Leavitt Partners, the project will identify promising practices and practical operational guidance that organizations could implement. 

Accountable Care Organizations (ACOs) offer an important strategy for improving care for serious illness populations. ACOs are by far the largest alternative payment model sponsored by Medicare, and the number of commercial ACO contracts is growing rapidly. ACOs are powerful vehicles for improving serious illness care given the incentives ACOs have to deliver effective, efficient, and coordinated care that improves outcomes and quality of life without increasing costs. While ACOs have great potential in improving serious illness care, there remains substantial opportunities for improvement due to a lack of evidence on what works, a need for practical guidance, and challenges in implementing new initiatives.

“Providing healthcare for people with serious illnesses is incredibly complex and involves medical and social services from a variety of providers and caregivers,” said Duke-Margolis Director Mark McClellan, MD, PhD, “ACOs are a potentially powerful way to improving serious illness care in an effective, efficient, and coordinated way.”

“The challenge is that we do not have a broad evidence base on what works and could serve as a best practice for accountable care in cases of serious illness across the spectrum of providers and settings,” said Robert Saunders, PhD, who leads the project.

“To realize the potential of the ACO model, organizations have to redesign their care models. For ACOs to be successful, they need operational guidance on how to identify patients with serious illness and how to improve care for this population of patients,” said David Muhlestein, PhD, JD, chief research officer for Leavitt Partners.

The Moore Foundation grant, part of its Patient Care Program which is focused on improving the experience and outcomes of patient care, will enable the team to complete a comprehensive review of the available research, convene stakeholders who have expertise in the area of serious illness and accountable care, develop a series of case studies outlining best practices and lessons learned, and analyze quality and claims data to identify factors affecting serious illness care. The Duke-Margolis Center and Leavitt Partners will work with partners to disseminate these findings so that healthcare providers and systems implementing accountable care can learn from successful organizations.

The project builds on previous work by the Center defining strategies for ACO success, as well as prior collaborative work by the Center and Leavitt Partners tracking ACO growth and analyzing ACO performance over time. This portfolio of projects, including accountable care in the United States and globally, demonstrate how organizations can succeed under new delivery arrangements to provide integrated, comprehensive care at lower cost to patients.