Innovation for High-Need, High-Cost Patients in the U.S.

The Duke Global Health Innovation Center and Duke-Margolis are partnering with the Commonwealth Fund on a new project to identify ways to serve high-need, high-cost patients that span both accountable care payment reforms and healthcare delivery innovations.

High-need patients are not always well-served by the traditional fee-for-service payment model in the United States.  Building on previous work evaluating innovations from a variety of international contexts, a research team led by Mark McClellan, MD, PhD, and Krishna Udayakumar, MD, MBA, will spend the next seven months working with an advisory board made up of potential implementation partners, consumer advocates, employers, and private healthcare purchasers and engage existing innovation networks.

Together, they will refine an approach to integrate innovations that encompass both accountable care payment reforms – in which a group of providers are held jointly accountable for achieving a set of outcomes for a defined population over a period of time and for an agreed cost – and new models of care delivery that are supported by this shift toward payment for outcomes.

“Over the last two years, our teams have been collaborating with the Commonwealth Fund and have successfully identified a number of global models to support integrated delivery and payment reform that may be translated into a U.S. context,” said Udayakumar. “This effort, which is the first phase of a larger project to develop and test innovations, will convene important stakeholders to identify critical patient and system needs and refine a framework to identify global solutions to meet those needs. Future phases will include curation and adaptation of global payment and delivery innovations, as well as testing and scaling these integrated solutions to contain costs and ensure high quality healthcare in the United States.”