Pennyhill Park
Bagshot, England
July 17-19, 2009

Since 1999, the Fund and The Nuffield Trust have sponsored annual symposia that have brought together senior government officials, leading health researchers, and practitioners from the United States and the United Kingdom for an exchange on quality improvement policies and strategies. These forums have provided a unique opportunity for building relationships among senior policymakers in participating countries, showcasing innovations in quality improvement, and facilitating an ongoing exchange on what works and what does not in the quality arena. The theme of the 10th conference in this series was the use of provider payment policies to improve quality, integration of care, and costs for chronically ill patients. The meeting examined the potential to improve performance through annual global fees and episode-of-care-based fees, payment methods for integrated models of care, and financial incentives for provider organizations that reflect accountability for both quality and costs. Experience to date with innovative integrated care delivery models in the U.K. and U.S. further informed the work of the Commission on a High Performance Health Care System and thinking about U.S. health reform.

In keeping with the goals of the annual collaboration, the 2009 meeting generated innovative thinking on improving integration of care for patients with chronic illness, with an emphasis on the necessity of working on multiple organizational levels, including within systems, groups, organizations, and on the level of the individual practitioner, as well as on multiple dimensions within these levels, including leadership, culture, team development, information technology (IT), and incentives. Highlights included the importance of outcome measurement and culture/behavior change, the importance of keeping patients’ experiences at the forefront of improving quality and integration of care, infrastructure changes necessary for payment reform, and continuing gaps in care coordination and basic performance measures. Innovative strategies for addressing these challenges at the organizational level were presented in case studies from the U.S. and the U.K. Case studies were presented by Benjamin K. Chu, Kaiser Permanente Southern California; Peter Colclough, Torbay Primary Care Trust; Martin Connor, Trafford Primary Care Trust; Karl J. Ulrich, Marshfield Clinic; Anne Hendry, Long Term Conditions Collaborative in Scotland; and Ronald P.G. Walshe, University of Cologne. Ultimately, the importance of clinicians and patients working together, simplifying care and reducing fragmentation, and increasing integration across silos became the calls to action resulting from this collaboration—"creating coherence out of chaos."

Additional highlighted speakers included Mark B. McClellan, Brookings Institution; Susan Dentzer, Health Affairs; and Rebecca Rosen, The Nuffield Trust. The meeting was hosted by John Craig and Robin Osborn of The Commonwealth Fund, and Dame Carol Black and Jennifer Dixon of The Nuffield Trust, with content support from Sir Liam Donaldson, Chief Medical Officer, England, and Carolyn Clancy, director of the Agency for Healthcare Research and Quality. The meeting was facilitated by Professor Chris Ham, University of Birmingham.