Healthcare Delivery Reform

Healthcare systems and governments are embracing innovation toward more personalized, prevention-oriented care, while facing growing pressure to address the rising cost of care. At the same time, the system is burdened by the demographic challenge of increasing numbers of patients with complex healthcare needs, including multiple chronic conditions requiring team-based care and coordination. Without effective solutions, clinician burdens are increasing, with more providers reporting that they are overwhelmed by care coordination, documentation, and compliance requirements.

Recent reforms have aimed to encourage a shift away from fee-for-service to value-based financing approaches and the adoption of these models by private insurers. But all these efforts are occurring in an environment of uncertainty due to limited evidence on the most effective approach to reform.  Systems in the US and around the world have not solved the question of how to pay for care in a way that encourages this shift to high-value, innovative care and how to empower patients and consumers to help lead it.

Our Approach

Duke-Margolis draws on expertise from across Duke University to create the research and data infrastructure necessary for empirical analysis of challenging healthcare delivery and payment reform questions. Working with the Duke Clinical Research Institute and other collaborators, Duke-Margolis is creating an Evidence Hub that will bring together expertise, best practices, and multiple data sources under shared governance structures for data curation and use. This resource will empower faculty and research teams to address key policy questions related to health care delivery, with particular attention to payment reform. The Center will also collaborate with multiple entities within Duke Health to create structures necessary for piloting new ideas to deliver, finance, and regulate health care. The work will be at multiple levels, from supporting Duke Health’s strategic direction and leadership in care delivery, to state and regional improvements, to national policies, to international collaborations.

Current directions include:

  • Multicenter payment reform evaluation
  • Support Duke strategy and care redesign, preparation for MACRA and Medicaid reform, and to lead further state and national efforts in payment reform
  • Evidence-driven quick turnaround feedback on MACRA implementation
  • Primary-specialty care collaboration and coordination
  • Digital health approaches to preventive, well-coordinated, and efficient care
  • Implementing accountable care worldwide
  • Health care payment reform to support population health improvement initiatives

In the future, the Center will work to build distributed data infrastructure with other institutions to facilitate comprehensive data and empirical analysis of reforms to evaluate effectiveness from multiple perspectives (patient, physician, payer, societal) and identify unintended consequences. Other opportunities include evaluating impact of care teams including community health workers and other low-cost, population-based approaches to care and payment and research on payment and benefit design that incorporates the patient perspective.

Our Projects

Accountable Care Forum - World Innovation Summit for Health

Healthiest Cities and Counties Challenge

Implications of Global Experiences with Accountable Care

Increasing patient and system value with community based palliative care

Mapping Global Health Research and Development

Payment Reform Evidence Hub

Second Panel on Cost-Effectiveness in Health and Medicine