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NAMOur WorkProgramsLeadership ConsortiumCommission on Investment Imperatives for a Healthy NationFunding and Accountability Workstream

Workstream 2: Funding and Accountability

Health financing that drives individual and community health and well-being.

Problem Statement

Most medical care is still billed by individual units of service, and therefore encourages more services, higher costs, and narrower perspectives than may be necessary for the circumstances. This exacerbates care and system fragmentation that leads to higher expenditures and performance shortfalls, and, in effect, often discourages care continuity, effectiveness, efficiency, equity, and improvement in the health of communities.

Workstream Charge

The Health Financing and Accountability workstream will uplift alignment challenges, opportunities, and impacts related to financial incentives that reward the achievement of individual and community health goals. Workstream members will produce a background paper that will inform Commission deliberations on the associated opportunities, priorities, and implications dependent on correcting the alignment of values, incentives, policies, and actions.

The paper will:

  1. review U.S. health system status and trends for financial incentives and accountability for health;
  2. describe how misaligned incentives and poor accountability contribute to a multitude of system shortfalls;
  3. identify salient contributors to the problem;
  4. identify accountability disconnects;
  5. estimate the health and economic costs of maintaining the status quo;
  6. estimate the potential health and economic gains to health system stakeholders and/or society from financial incentives and accountability for health;
  7. identify legal, regulatory, or cultural levers to drive the change from where we are now to a better future state; and
  8. describe promising strategies for marshaling the will to deploy the necessary levers at the right place, at the right time.

Workstream Members

Chairs

Director, Health Analytics
Dartmouth
Founder and CEO
Simple Healthcare

Ex officio (Value Incentives and Systems Action Collaborative co-chairs)

President and CEO
UPMC Health Plan

Diane P. Holder is executive vice president and president of the UPMC Insurance Services Division, and president and CEO of UPMC Health Plan. UPMC is one of the nation’s leading integrated delivery systems and through its health plans and affiliates, provides health coverage and benefit management for 3.4 million men, women and children in Pennsylvania. The Insurance Services Division includes the UPMC Health Plan, UPMC for You, Community Care Behavioral Health Organization and Work Partners. These health benefits companies manage benefits for Commercial, Medicaid, Medicare, Behavioral Health, EAP, Health Promotions and Worker’s Compensation programs.

Ms. Holder has held a number of leadership positions in health care including the CEO of UPMC’s Western Psychiatric Institute and Clinic and the founding CEO of Community Care Behavioral Health Organization. Ms Holder is a faculty member of the University of Pittsburgh Department of Psychiatry and a faculty member of Pitt’s Graduate School of Public Health. She received her undergraduate degree from the University of Michigan and her master’s degree from Columbia University.

CEO
American Medical Association

James L. Madara, MD, serves as the CEO and executive vice president of the American Medical Association, the nation’s largest physician organization. He holds the academic title of adjunct professor of pathology at Northwestern University.

Since taking the reins of the AMA in 2011, Dr. Madara has helped sculpt the organization’s visionary longterm strategic plan. As an extension of this vision, he now also serves as chairman of Health2047 Inc., an independent, design-driven innovation firm based in San Francisco and whose mission is to help advance the AMA’s goal of improving the health of the nation.

Prior to arriving at the AMA, Dr. Madara spent the first 22 years of his career at Harvard Medical School, receiving both clinical and research training, serving as a tenured professor and as director of the NIH-sponsored Harvard Digestive Diseases Center. Following five years as chair of pathology at Emory, Dr. Madara served as dean of the medical school and CEO of the hospitals at the University of Chicago, bringing together the university’s biomedical research, teaching and clinical activities. While there he oversaw the renewal of the institution’s biomedical campus and engineered significant new affiliations with community hospitals, teaching hospital systems, community clinics and national research organizations.

Dr. Madara also served as senior advisor with Leavitt Partners, an innovative health care consulting and private-equity firm founded by former Secretary of Health and Human Services, Mike Leavitt.

Having published more than 200 original papers and chapters, Dr. Madara has received both national and international awards, and served as editor-in-chief of the American Journal of Pathology and as president of the American Board of Pathology.

In addition to Modern Healthcare consistently naming him as one of the nation’s 50 most influential physician executives, as well as one of the nation’s 100 most influential people in health care, he is a past recipient of a prestigious MERIT Award from the National Institutes of Health. He received the 2011 Davenport Award for lifetime achievement
in gastrointestinal disease from the American Physiological Society and the 2011 Mentoring Award for lifetime achievement from the American Gastroenterological Society.

Dr. Madara is an elected member of both the American Society of Clinical Investigation and the Association of American Physicians. He also cochairs the Value Incentives and Systems Innovation Collaborative of the National Academy of Medicine (NAM), and is a member of NAM’s Leadership Consortium for Value & Science-Driven Health Care.

Members

Bloomberg Distinguished Professor of Health Policy and Economics and Founder, Center for Health Systems and Policy Modeling, Johns Hopkins University
Chief Policy Officer
Aledade
Chief Medical Officer, Cincinnati Children’s Hospital Medical Center
Co-Director, Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation Program Office
Director Division of Policy and Evidence Review, Centers for Medicare and Medicaid Services
Vice President and Chief Policy and Prevention Officer, Nemours Children’s Health
2023-2025 Puffer/ABFM Fellow

Dr. Gold is an Associate Professor in the Department of Family Medicine at the University of Colorado, a practicing family physician at a federally qualified health center in the Denver Health system, and a Scholar at the Farley Health Policy Center. Her research and policy work focus on payment reform for primary care and integrating behavioral health with primary care, with the goal of system transformation to enable primary care to better and more equitably care for the whole heath of individuals, families, and communities.

Dr. Gold served as president of the Colorado Academy of Family Physicians (CAFP) from 2022-2023. Through the CAFP, Dr. Gold helped advance legislation to improve primary care investment in Colorado and has provided input on multiple state task forces and committees related to primary care payment reform. Dr. Gold co-edited a book, Integrated Behavioral Health in Primary Care: Your Patients are Waiting, which provides guidance on practice transformation to integrate care. She led the development of the Building Blocks of Behavioral Health Integration, a framework of care delivery expectations for use in practice transformation and alternative payment models. Dr. Gold also teaches policy and advocacy skills and has developed novel curricula for residents and international learners.

Dr. Gold received her MD from the University of Virginia School of Medicine and completed her residency at the University of Colorado – Denver Health track. Following residency, she completed a health policy fellowship with the Farley Health Policy Center.

Chief of Medical Benefits and Reimbursement, TRICARE/Defense Health Agency
former Chief Value-Based Solutions Officer, Signify Health
former Director, Value-based Purchasing, Purchaser Business Group on Health
former Executive Director, Families USA
Chief Transformation Officer, Centers for Medicare and Medicaid Services
Founder and Chief Medical Officer, Medical Home Network
Vice President, Nationwide Children’s Hospital
Division Chief of General Internal Medicine, UT Southwestern Medical Center
CEO, Accountable for Health
Executive Director, Institute for Accountable Care
President, Health Quality Advisors LLC
former Executive Director, Ohio Governor John Kasich’s Office of Health Transformation
Professor, UCLA Fielding School of Public Health
Executive Officer and Director of Operations, Office of Healthcare Innovation and Learning’s Center for Care and Payment Innovation, Veterans Health Administration
Assistant Professor, Divisions of Healthcare Delivery Science and Medical Ethics, NYU Grossman School of Medicine Department of Population Health

Contact Information

Questions?

For additional information on workstream activities, contact Amanda Hunt ([email protected]).

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