The Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century recommended a redesign of the American health care system by providing six Aims for Improvement: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity. These ‘aims’ established a specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others to follow in improving the US health care system.

With the passage of the Affordable Care Act (ACA), we are experiencing a significant redesign of the health care system. This redesign and the emerging models are focused on what you may often hear referred to as the "Triple Aim". Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance by 1. improve the health of the population; 2. enhance the patient experience of care (including quality, access, and reliability); and 3. reduce, or at least control, the per capita cost of care. Source: Institute for Health Improvement

The following are some of these emerging health system delivery and payment models. Click on the model below to get more information including a description and examples of how it connects to 1305 Domain 3 cardiovascular and diabetes strategies and performance measures.

Understanding Health Systems Reform
  • Federal-State Discourse on Maintaining Momentum for Payment and Delivery System Reform (National Academy for State Health Policy, July 2016)
  • Health Payer 101 Webinar Series, May/June 2016 (NACDD and CDC Program Development and Services Branch, Division for Heart Disease and Stroke Prevention)

    The Basics, Part 1 (recording): Overview of health insurance products and plans; managed care organization structure and services Slides

    The Basics, Part 2 (recording): Insurance: employer, individual, Medicaid and Medicare; Reimbursement Models: fee-for-service, bundled payment; Incentives: pay-for-performance (P4P) and shared savings Slides

    Setting the Table Proactively, Part 3 (recording): Data: Where does it come from and how is it used; how states are working with payers Slides

    Contracting 101, Part 4 (recording): Network development: individual contracts, Accountable Care Organizations and Independent Physician Associations; provisions of a provider contract; providers and payers relationship building Slides

  • Toward Sustainable Improvements in Population Health: Overview of Community Integration Structures and Emerging Innovations in Financing (CDC)
  • Understanding Healthcare Payment Reform Matrix of Payment Reform Activities (NACDD G.E.A.R. Matrix)
Reform Initiatives

Public Health Departments and Accountable Care Organizations (CDC) focuses on the interface of public health departments and ACOs and highlights opportunities for enhanced collaboration between the two entities.