November 13, 2020

Accountable Care Reforms Hold Promise to Improve Global Health

Today at the World Innovation Summit for Health (WISH), a global initiative of Qatar Foundation for Education, Science and Community Development (QF), a team from Duke-Margolis presented policy recommendations on accountable care in the global context.

Accountable care, a framework under 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,” seeks to address population health needs more effectively and at a lower cost by aligning health financing and policy with person-centered care reforms. 

This is a very different way of organizing and providing care, and implementing accountable care requires new organizational capabilities, professional expectations, performance measures and financing models – plus support for organizations in managing change. The Duke-Margolis team highlighted the applicability of accountable care reforms in diverse settings around the world through eight case studies of accountable care implementation in low-, middle-, and high-income countries, identifying three models for patient-centered healthcare innovations:  primary-care focused reforms that build efficient access to low-cost primary care services and coordination with specialized care; problem-focused care reforms promoting access to more efficient, high-quality services for ‘episodes’ of care for specific conditions; and comprehensive care reforms that require accountability for the full spectrum of care across a population.

The successful programs shared several practical approaches including enabling strong clinical leadership, developing low-cost technology solutions, leveraging local human resources to speed up implementation, supporting better-functioning teams of providers, encouraging patients to use the most cost-efficient site for care and linking payments to outcomes at the person level instead of a set fee for a given service.

The team identified key policy recommendations to strengthen and accelerate accountable care reforms globally, include shifting to regulatory requirements focused on patients, not providers; supporting organizations in developing new capabilities; aligning financial and non-financial incentives and supports to change both provider and population behavior; and collaborating broadly with providers, population groups and other stakeholders to build trust and adapt policies to local conditions.

The team, including center director Mark McClellan, managing associate Andrea Thoumi, and Krishna Udayakumar, associate professor of Global Health and Medicine, along with Hannah Patel of Imperial College London and Professor Abdul Badi Abou Samra of Hamad Medical Corporation, presented the report of the WISH Accountable Care Forum, Implementing Accountable Care to Achieve Better Health at a Lower Cost.

Previously posted here by the Margolis Center for Health Policy at Duke University.