%PDF-1.3
%
16 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
12 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
7 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
21 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
10 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
24 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
11 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
6 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
27 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
13 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
25 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
3 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
14 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
28 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
20 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
1 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
4 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
23 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
9 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
5 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
8 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
19 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
18 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
17 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
26 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
15 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
22 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
30 0 obj
<>stream
Acrobat Distiller 8.1.0 (Windows); modified using iText 4.2.0 by 1T3XT
Arbortext Advanced Print Publisher 9.0.114/W
2015-05-08T06:07:25-07:00
2015-02-05T12:48:23+05:30
application/pdf
untitled
uuid:5d166b25-4f6b-455c-96e6-2cd58430b39d
uuid:5a5bc623-ac48-4c6d-9f19-f449c38c9377
endstream
endobj
31 0 obj
<>stream
x+ |
endstream
endobj
32 0 obj
<>stream
xS**T0T0 BiU)D* 9V
endstream
endobj
33 0 obj
<>stream
x+ |
endstream
endobj
34 0 obj
<>stream
xS**T0T0 Bih]9D. qaj
endstream
endobj
35 0 obj
<>stream
x+ |
endstream
endobj
36 0 obj
<>stream
xS**T0T0 Bih]D. r^j
endstream
endobj
37 0 obj
<>stream
x+ |
endstream
endobj
38 0 obj
<>stream
xS**T0T0 BiUD* 8
endstream
endobj
39 0 obj
<>stream
x+ |
endstream
endobj
40 0 obj
<>stream
xS**T0T0 Bih] D. pa
endstream
endobj
41 0 obj
<>stream
x+ |
endstream
endobj
42 0 obj
<>stream
xS**T0T0 Bid]1D. pa
endstream
endobj
43 0 obj
<>stream
x+ |
endstream
endobj
44 0 obj
<>stream
xS**T0T0 BiUD* :
endstream
endobj
45 0 obj
<>stream
x+ |
endstream
endobj
46 0 obj
<>stream
xS**T0T0 BiU !D. _e1
endstream
endobj
47 0 obj
<>stream
x+ |
endstream
endobj
48 0 obj
<>stream
xS**T0T0 Bid]D. qdj
endstream
endobj
51 0 obj
<>stream
/GS1 gs
BT
/F4 1 Tf
9.843 0 0 9.843 59.7543 725.1588 Tm
0 0 0 1 k
0 Tc
0 Tw
[(Baumols)-259.8(argument)-260.1(does)-253(not)-256.9(imply)-254.7(that)-253.5(we)-257.7(cannot)-256.7(or)-255.6(should)]TJ
0 -1.1174 TD
[(not)-389.3(address)-389.8(the)-390.5(rising)-386.8(costs)-392.3(of)-388.1(health)-389.3(care.)-391.4(Despite)-391.1(the)-384.7(in-)]TJ
0 -1.1116 TD
[(evitable)-421.6(increase)-422.3(in)-411.3(unit)-419.4(cost)-414.4(of)-416.9(services,)-418.6(health)-418.1(care)-416.8(pro-)]TJ
T*
[(viders)-462.7(must)-454.8(ensure)-463.7(that)-455.1(the)-459.6(most)-454.8(effective)-464(treatments)-459.4(are)]TJ
T*
[(available)-285.7(at)-285.7(the)-281.1(appropriate)-286.5(place)-285.6(and)-280.9(at)-280(the)-281.1(right)-282.2(time.)-287(That)]TJ
0 -1.1174 TD
[(is,)-362.7(at)-366.4(least)-365(in)-359.4(the)-361.7(United)-366(States,)-363.6(the)-361.7(cost)-362.6(of)-365(available)-366.3(treat-)]TJ
0 -1.1116 TD
[(ment)-323.7(options)-324.6(has)-326.8(no)-324.7(impact)-321.5(on)-324.7(whether)-327.8(a)-324.8(given)-323.6(option)-323.7(will)]TJ
T*
[(be)-325.9(deployed.)-320(At)-320(the)-321.4(same)-324.5(time,)-321.5(taxpayers)-324.3(bear)-323.5(a)-324.8(signicant)]TJ
0 -1.1174 TD
[(portion)-376.6(of)-376.5(health)-383.6(care)-376.5(costs)-380.8(and,)-376.5(in)-376.7(return,)-374.1(expect)-378.9(efcient)]TJ
0 -1.1116 TD
[(and)-522.8(high-quality)-521.7(health)-527.6(care.)-523.9(Meeting)-523.8(these)-520.4(expectations)]TJ
T*
[(will)-426.1(require)-424.8(reforming)-427(many)-427.3(interrelated)-427.3(facets)-424.7(of)-422.6(the)-425.1(US)]TJ
0 -1.1174 TD
[(health)-337.5(care)-336.2(system.)]TJ
1.0137 -1.1116 TD
[(Two)-310.6(decades)-311.7(ago,)-313.2(in)-307.6(response)-316(to)-307.6(the)-309.9(rising)-311.9(cost)-310.8(of)-307.4(health)]TJ
-1.0137 -1.1116 TD
[(care,)-454.8(C.)-454.8(Everett)-455(Koop)-448.8(and)-453.7(his)-452.5(colleagues)-453.5(argued)-458.2(that)-449.3(we)]TJ
T*
[(must)-310.8(reduce)-315.3(the)-309.9(need)-312(and)-309.7(demand)-309.7(for)-308.5(health)-314.5(care.)]TJ
7.3823 0 0 6.5614 260.6172 576.1132 Tm
(2)Tj
9.843 0 0 9.843 267.307 571.7479 Tm
[(In)-313.2(other)]TJ
-21.0863 -1.1174 TD
[(words,)-268.8(the)-269.5(most)-270.5(effective)-273.9(way)-264.5(to)-267.3(reduce)-275(utilization)-268.6(of)-267.1(health)]TJ
0 -1.1116 TD
[(care)-439.8(services,)-435.9(and)-430.7(the)-436.6(corresponding)-437(total)-433.3(cost)-437.5(of)-428.4(care,)-437.5(is)]TJ
T*
[(to)-347.9(keep)-340.8(people)-348.9(well.)-344.2(There)-348.8(are)-345.4(2)-340.9(ways)-346.1(to)-347.9(lower)-341.7(utilization.)]TJ
0 -1.1174 TD
[(First,)-394.7(as)-389.1(prescribed)-394.5(by)-393.9(Koop)-391.2(and)-390.4(colleagues,)-393.5(utilization)-395.4(of)]TJ
0 -1.1116 TD
[(services)-277(will)-270.6(decrease)-279.3(if)-273(the)-269.5(prevalence)-276.1(of)-272.9(chronic)-269.3(disease)-275.9(is)]TJ
T*
(reduced.)Tj
7.3823 0 0 6.5614 93.4866 510.3495 Tm
(3)Tj
9.843 0 0 9.843 103.0677 505.9841 Tm
[(Second,)-599.7(improving)-593.1(case)-600.9(management)-600(and)-592(the)]TJ
-4.4004 -1.1174 TD
[(coordination)-257.8(of)-255.6(care)-255.5(for)-256.7(those)-254.3(individuals)-255.5(who)-251.8(do)-255.6(become)-253.2(ill)]TJ
0 -1.1116 TD
[(will)-478(reduce)-482.4(utilization)-476(by)-480.3(avoiding)-476.8(unnecessary)-482.9(tests)-473.1(and)]TJ
T*
[(procedures)-296.5(and)-292.4(thus)-292.3(reducing)-293.5(the)-292.6(rate)-294.8(of)-295.9(adverse)-293.2(events)-296.9(and)]TJ
0 -1.1174 TD
(complications.)Tj
7.3823 0 0 6.5614 117.6944 466.5258 Tm
(4)Tj
9.843 0 0 9.843 69.7323 451.1621 Tm
[(Th)19.6(e)-486.1(p)0(u)20.8(r)0(p)20.9(o)0(s)21(e)-486.1(of)-474.5(th)20.7(is)-474.4(st)20.9(ud)20.8(y)-484.9(i)0(s)-474.4(t)0(o)-468.9(e)0(v)19.7(a)0(l)13.8(u)0(a)19.7(t)0(e)-470(t)0(h)15(e)-480.3(im)19.5(pa)19.7(ct)-475.8(of)]TJ
-1.0137 -1.1116 TD
[(pa)13.9(ti)20.6(en)19.7(t-)20.7(ce)18.5(nt)20.7(er)14(ed)-222.2(me)18.4(di)20.7(ca)18.5(l)-237.4(h)0(o)20.8(m)0(e)18.4(s)-237(\(P)21(CM)18.9(Hs)14.4(\))-231.5(o)0(n)-226.8(t)0(o)20.7(t)0(a)19.6(l)-237.4(he)19.7(al)19.5(th)-227(ca)18.5(re)]TJ
T*
[(co)13.9(st)20.9(s)-363.8(o)0(v)20.8(e)0(r)-360.4(a)-365.1(5-)20.9(ye)13.9(ar)-354.7(pe)19.7(ri)20.7(od)15.1(.)-360.5(S)0(p)15.2(e)0(c)18.5(i)0()20.9(c)0(a)18.5(l)0(l)20.6(y)0(,)-355.9(t)0(h)20.7(e)-370.9(st)20.9(ud)20.8(y)-369.7(e)0(x)19.7(a)0(m)18.5(i)0(n)20.7(e)0(s)]TJ
0 -1.1174 TD
[(th)15(e)-480.3(u)0(t)20.7(i)0(l)20.6(i)0(z)19.6(a)0(t)13.8(i)0(o)20.7(n)-479.1(ra)19.7(te)-475.8(an)19.7(d)-479.1(p)0(e)13.9(r)-479.1(un)20.8(it)-474.8(co)19.7(st)-468.7(of)-474.5(ca)18.5(re)-475.6(fo)20.9(r)-479.1(d)0(i)20.7(f)0(f)15.1(e)0(r)19.7(e)0(n)19.7(t)]TJ
0 -1.1116 TD
[(ca)18.5(te)13.8(go)20.8(ri)20.7(es)-377.5(of)-382.3(he)19.7(al)19.5(th)-376.7(ca)18.5(re)-383.5(se)19.9(rv)20.9(ic)19.6(es)-383.3(ac)18.5(ro)20.9(ss)-376.2(di)20.7(ff)15.1(er)19.7(en)19.7(t)-387.1(p)0(a)19.7(y)0(e)13.9(r)0(s)-376.4(i)0(n)]TJ
T*
[(th)15(e)-353.6(S)0(t)20.9(a)0(t)13.8(e)-353.6(of)-347.7(Ve)18.8(rm)19.6(on)15.1(t)-352.6(p)0(u)20.8(r)0(s)15.3(u)0(a)19.7(n)0(t)-347.9(t)0(o)-347.9(t)0(h)20.7(e)-359.4(im)19.5(pl)20.7(em)18.5(en)19.7(ta)19.6(ti)20.6(on)-347.8(of)-347.7(th)20.7(e)]TJ
0 -1.1174 TD
[(Ve)18.8(rm)13.9(on)20.8(t)-427.4(B)0(l)19.7(u)0(e)19.7(p)0(r)15.1(i)0(n)20.7(t)-427.4(fo)20.9(r)-427.3(H)0(e)13(a)0(l)19.5(t)0(h)-417(\()0(V)20(B)0(H)18.9(\))0(.)-419.2(V)0(B)18.9(H)-433.9(is)-416.8(a)-428.5(s)0(t)15.1(a)0(t)19.5(e)0(w)18.8(i)0(d)20.7(e)]TJ
0 -1.1116 TD
[(im)19.5(pl)14.9(em)18.5(en)19.7(ta)19.6(ti)20.6(on)-365.1(of)-365(a)-370.9(n)0(o)15.1(v)0(e)19.7(l)-369.8(de)13.9(li)20.6(ve)19.7(ry)-365(sy)21(st)20.9(em)-367.4(mo)19.6(de)19.7(l)-375.6(b)0(a)19.7(s)0(e)19.9(d)-375.5(on)]TJ
T*
[(PC)14.2(MH)19.1(s)-352.2(t)0(h)20.7(a)0(t)-343.3(i)0(s)-342(f)0(o)20.9(c)0(u)19.7(s)0(e)19.9(d)-352.4(on)-342(im)19.5(pr)20.9(ov)15.1(in)20.7(g)-352.4(p)0(r)20.9(e)0(v)19.7(e)0(n)19.7(t)0(i)20.6(v)0(e)-343.2(h)0(e)13.9(a)0(l)19.5(t)0(h)-342.1(s)0(e)19.9(r)0(-)]TJ
0 -1.1174 TD
[(vi)14.9(ce)18.5(s)-260.1(f)0(o)15.1(r)-260.3(al)13.8(l)-260.4(c)0(i)19.5(t)0(i)14.8(z)0(e)18.5(n)0(s)21(.)-262.6(Pr)15.3(es)19.9(um)19.6(ab)19.7(ly)20.7(,)-262.6(P)0(C)14.2(M)0(H)19.1(s)-265.8(re)19.7(su)21(lt)-255.9(in)-255.8(im)19.5(pr)20.9(ov)20.8(ed)]TJ
0 -1.1116 TD
[(co)13.9(or)20.9(di)20.7(na)19.7(ti)20.6(on)-307.5(of)-313.2(ca)18.5(re)-308.6(th)20.7(at)-308.8(sh)15.3(ou)20.8(ld)-307.6(pr)20.9(ev)19.7(en)19.7(t)-323.8(t)0(h)20.7(e)-319(on)20.8(se)19.9(t)-318(o)0(f)-307.4(d)0(i)15(s)0(e)19.9(a)0(s)19.9(e)]TJ
T*
[(or)-295.9(pr)20.9(ov)20.8(id)20.7(e)-307.5(b)0(e)19.7(t)0(t)20.6(e)0(r)-291.3(d)0(i)14.9(s)0(e)19.9(a)0(s)19.9(e)-301.8(st)20.9(at)13.8(e)-301.8(m)0(a)18.4(n)0(a)19.7(g)0(e)19.7(m)0(e)18.4(n)0(t)-290.3(a)0(n)13.9(d)-300.6(sl)20.9(ow)-291.1(di)15(se)19.9(as)19.9(e)]TJ
T*
[(st)15.1(at)19.5(e)-226.9(p)0(r)20.9(o)0(g)20.8(r)0(e)14(s)0(s)21.2(i)0(o)20.7(n)0(.)-217.6(T)0(h)19.6(e)-226.9(re)19.7(su)15.3(lt)-215.6(sh)21(ou)20.8(ld)-221.2(be)-216.5(lo)20.7(we)18.8(r)-225.7(r)0(a)14(t)0(e)19.5(s)-225.5(of)-215.3(in)15(pa)19.7(ti)20.6(en)19.7(t)]TJ
0 -1.1174 TD
[(ho)15.1(sp)21(it)20.6(al)19.5(iz)19.6(at)13.8(io)20.7(n)-548.3(a)0(n)19.7(d)-548.3(em)18.5(er)19.7(ge)19.7(nc)19.7(y)-548.3(d)0(e)19.7(p)0(a)19.7(r)0(t)20.7(m)0(e)18.4(n)0(t)-538(v)0(i)15(s)0(i)20.9(t)0(s)20.9(.)-550.6(Be)18.6(ca)18.5(us)21(e)]TJ
0 -1.1116 TD
[(th)15(os)21(e)-474.6(h)0(e)19.7(a)0(l)19.5(t)0(h)-468.9(c)0(a)18.5(r)0(e)-464.1(s)0(e)14.1(r)0(v)20.9(i)0(c)19.6(e)0(s)-469.7(a)0(r)19.7(e)-474.6(am)18.5(on)20.8(g)-479.1(t)0(h)20.7(e)-474.6(mo)19.6(st)-468.7(ex)19.7(pe)19.7(ns)21(iv)20.7(e,)]TJ
T*
[(th)15(er)19.7(e)-336.3(s)0(h)21(o)0(u)20.8(l)0(d)-324.9(b)0(e)-331.7(a)-336.3(co)19.7(rr)20.9(es)19.9(po)15.1(nd)20.8(in)20.7(g)-335.2(d)0(e)19.7(c)0(r)19.7(e)0(a)18.5(s)0(e)-331.5(i)0(n)-324.9(p)0(e)19.7(r)-335.1(pa)19.7(ti)20.6(en)13.9(t)-335.3(c)0(o)19.7(s)0(t)]TJ
0 -1.1174 TD
[(of)-313.2(ca)12.8(re)19.7(.)]TJ
/F9 1 Tf
8.9663 0 0 8.9663 59.7543 248.4283 Tm
[(Literature)-340.2(review)]TJ
/F4 1 Tf
9.843 0 0 9.843 69.7323 231.9873 Tm
[(It)-238.4(is)-238.3(well)-237.1(known)-242.5(that)-236.2(the)-240.7(incentives)-239.3(and)-240.6(goals)-237(of)-238.3(US)-239.1(health)]TJ
-1.0137 -1.1116 TD
[(care)-341.9(stakeholders)-344.9(are)-339.7(often)-340.8(incongruent.)-340.7(Fee-for-service)-344.5(re-)]TJ
0 -1.1174 TD
[(imbursement)-650.5(models)-642.5(incentivize)-645.1(providers)-644.5(to)-641.7(maximize)]TJ
0 -1.1116 TD
(utilization.)Tj
7.3823 0 0 6.5614 102.4441 203.4708 Tm
(5)Tj
9.843 0 0 9.843 109.5307 199.1054 Tm
[(Capitated)-354.6(reimbursement)-354.3(models)-348.8(and)-344.3(managed)]TJ
-5.057 -1.1116 TD
[(care)-359.2(can)-351.2(incentivize)-357.1(selection)-353.4(bias)-356.8(and)-350(denial)-354.8(of)-353.5(care.)-356.9(Nei-)]TJ
T*
[(ther)-362.8(model)-365.1(promotes)-368.2(coordination)-361.5(among)-365(the)-361.7(tens)-362.6(of)-365(thou-)]TJ
0 -1.1174 TD
[(sands)-346.1(of)-342(distinct)-344.4(organizations)-340.5(that)-345.6(comprise)-346.3(the)-338.7(US)-342.7(health)]TJ
0 -1.1116 TD
[(care)-480.2(system.)]TJ
7.3823 0 0 6.5614 110.7779 159.6472 Tm
(6)Tj
9.843 0 0 9.843 119.1685 155.2818 Tm
[(Shared)-475.3(savings)-475.2(or)-474.5(pay-for-performance)-482.8(ini-)]TJ
-6.0362 -1.1116 TD
[(tiatives)-368.6(seek)-363.6(to)-365.2(overcome)-364.8(the)-361.7(limitations)-366.4(of)-359.3(fee)-368.5(for)-360.3(service)]TJ
0 -1.1174 TD
[(and)-355.8(capitation)-354.8(by)-347.8(encouraging)-355.5(prevention)-353.4(and)-350(coordination)]TJ
0 -1.1116 TD
[(of)-457.2(care.)-454.8(Under)-456.8(a)-451.5(shared)-458(savings)-457.9(arrangement,)-459.2(a)-451.5(group)-454.7(of)]TJ
T*
[(providers)-586.9(contracts)-583.6(to)-578.3(provide)-584.9(comprehensive)-584.6(care)-583.8(to)-578.3(a)]TJ
0 -1.1174 TD
[(dened)-515.6(population.)-511.3(If)-509(total)-508.2(cost)-512.4(of)-509(care)-514.7(is)-509(lower)-508.7(than)-512.6(a)]TJ
0 -1.1116 TD
[(predetermined)-538.8(benchmark)-533(and)-528.6(the)-534.5(quality)-527.6(of)-532.1(care)-532(meets)]TJ
T*
[(agreed-upon)-245.9(standards,)-245.8(the)-240.7(providers)-241.3(receive)-248.6(a)-238.4(portion)-244.1(of)-238.3(the)]TJ
0 -1.1174 TD
[(savings)-400.3(as)-400.6(a)-393.9()50.8(bonus.)46.7()-398.5(Although)-395.8(shared)-400.4(savings)-400.3(initiatives)]TJ
0 -1.1116 TD
[(have)-421.4(shown)-420.9(some)-421.3(promise,)-422.4(the)-419.3(results)-423.4(are)-420.3(still)-420.5(mixed.)]TJ
7.3823 0 0 6.5614 284.0881 61.0016 Tm
(7,8,9)Tj
9.843 0 0 9.843 310.8472 725.1588 Tm
[(Although)-430.4(some)-432.8(programs)-431.4(have)-432.9(demonstrated)-432.7(improved)-437.5(-)]TJ
0 -1.1174 TD
[(nancial)-789(and)-793.5(clinical)-796.1(outcomes,)-787.5(other)-795.8(initiatives)-792.6(show)]TJ
0 -1.1116 TD
[(equivocal)-336.2(results)-337(on)-330.5(both)-332.8(sets)-339.4(of)-330.5(metrics.)]TJ
/F9 1 Tf
8.9663 0 0 8.9663 310.8472 681.3352 Tm
[(PCMH:)-331.2(Vermonts)-337.4(experience,)-331.7(20072011)]TJ
/F4 1 Tf
9.843 0 0 9.843 320.8251 664.8943 Tm
[(Vermonts)-669.7(Blueprint)-669.1(model)-664.6(is)-664.5(designed)-673.4(to)-664.7(stimulate)]TJ
-1.0137 -1.1174 TD
[(transformation)-358.9(and)-355.8(provide)-360.3(citizens)-358.1(in)-353.7(each)-359.2(Health)-361.4(Service)]TJ
0 -1.1116 TD
[(Area)-462.6(\(HSA\))-462(of)-457.2(the)-459.6(state)-462.9(with)-460.6(access)-465.9(to)-457.3(high-quality)-464.1(pre-)]TJ
T*
[(ventive)-413.5(health)-418.1(services.)-424.4(The)-414.6(model)-417(includes)-414.4(statewide)-423.4(ex-)]TJ
0 -1.1174 TD
[(pansion)-319.8(of)-313.2(advanced)-324.5(primary)-315.4(care)-318.9(with)-322.3(practices)-319.9(qualifying)]TJ
0 -1.1116 TD
[(as)-389.1(PCMHs.)-391.5(Patients)-391.3(and)-390.4(families)-392.7(are)-391.5(supported)-391.1(in)-388.2(the)-390.5(pri-)]TJ
T*
[(mary)-421.5(care)-428.3(setting)-423.8(by)-422.7(multidisciplinary)-431.9(Community)-422.6(Health)]TJ
0 -1.1174 TD
[(Teams)-309.6(\(CHTs\))-314.7(that)-311.1(provide)-308.5(them)-312.2(with)-310.8(direct)-308.7(access)-316.1(to)-307.6(staff)]TJ
0 -1.1116 TD
[(such)-391.3(as)-394.8(nurse)-392.3(coordinators,)-393.4(social)-394.9(workers,)-393.1(counselors,)-396.6(di-)]TJ
T*
[(etitians,)-441.1(health)-435.4(educators,)-443(and)-436.4(others.)-437.3(CHT)-438.4(staff)-438.5(work)-437.2(di-)]TJ
T*
[(rectly)-412.3(with,)-406.4(and)-413.4(are)-408.8(often)-409.9(embedded)-411(within,)-414.5(PCMHs.)-408.8(The)]TJ
0 -1.1174 TD
[(result)-462.8(is)-457.1(a)-463(steadily)-460.6(expanding)-461.6(statewide)-463.7(network)-464.9(of)-457.2(inde-)]TJ
0 -1.1116 TD
[(pendently)-323.5(scored)-325.5(PCMHs)-319(whose)-324.1(patients)-328.1(and)-321.2(families)-323.6(have)]TJ
T*
[(improved)-276.3(access)-281.6(to)-273(multidisciplinary)-282.2(team-based)-281.7(services)-282.7(in)]TJ
0 -1.1174 TD
[(the)-465.4(practice)-468.7(setting,)-473.3(with)-466.3(better)-469.9(linkages)-466.2(to)-468.9(more)-467.5(holistic)]TJ
0 -1.1116 TD
[(health)-331.7(and)-338.5(human)-330.4(services)-340.3(in)-330.6(their)-335.2(community)-8(.)]TJ
1.0137 -1.1116 TD
[(Underlying)-491.3(this)-488.3(transformation)-491.4(are)-495.2(2)-484.9(targeted)-496.3(payment)]TJ
-1.0137 -1.1174 TD
[(reforms)-297.8(that)-293.8(involve)-297.1(the)-298.3(3)-294.8(major)-296(commercial)-300.6(insurers)-297.6(in)-296.1(the)]TJ
0 -1.1116 TD
[(state,)-616.1(Vermont)-610.1(Medicaid,)-615.9(and)-615(Medicare)-619.2(as)-607.9(part)-616.2(of)-612.7(the)]TJ
T*
[(Centers)-419.9(for)-417.9(Medicare)-423.4(&)-417(Medicaid)-422.4(Innovation)-421.3(Multi-Payer)]TJ
T*
[(Advanced)-295.4(Primary)-298(Care)-295.7(Practice)-301.5(demonstration.)-297.9(First,)-296.8(a)-296(per)]TJ
0 -1.1174 TD
[(person,)-264.4(per)-257.9(month)-266.1(payment)-264.8(is)-261.3(made)-261.4(directly)-264.9(to)-261.5(each)-267.1(primary)]TJ
0 -1.1116 TD
[(care)-503.2(practice)-503.3(or)-497.5(parent)-498.6(organization)-506.6(based)-497.2(on)-497.5(their)-502.2(most)]TJ
T*
[(recent)-344.3(score)-341.7(on)-342(the)-344.4(National)-340.7(Committee)-344.4(for)-343.1(Quality)-344.2(Assur-)]TJ
0 -1.1174 TD
[(ance)-336.2(\(NCQA\))-338.5(PCMH)-335.4(standards)-340.3(\(NCQA)-337.4(PCMH)-335.4(standards\).)]TJ
0 -1.1116 TD
[(Second,)-294.4(a)-296(payment)-293.6(is)-295.9(made)-295.9(to)-296.1(support)-289.8(CHT)-300.1(stafng)-296.6(in)-290.3(each)]TJ
T*
[(HSA)-482.9(at)-487.3(a)-486.1(ratio)-484.9(of)-486(1)-484.9(full-time)-485.1(equivalent)-487.2(for)-487.1(every)-485.9(4000)]TJ
0 -1.1174 TD
[(PCMH)-335.4(patients.)]TJ
1.0137 -1.1116 TD
[(VBH)-599.3(also)-598.8(is)-601.1(working)-601.9(with)-598.8(the)-603.6(Vermont)-598.6(Information)]TJ
-1.0137 -1.1116 TD
[(Technology)-435.1(Leaders)-444.1(to)-434.3(establish)-438.5(a)-440(statewide)-440.7(health)-435.4(infor-)]TJ
0 -1.1174 TD
[(mation)-337.6(network)-343.9(that)-339.9(populates)-340.6(a)-336.3(central)-345.5(registry)-338.3(capable)-346.6(of)]TJ
0 -1.1116 TD
[(supporting)-460.3(impro)-6.8(ved)-459.5(health)-464.2(and)-465.2(human)-462.9(services)-467(for)-464(indi-)]TJ
T*
[(viduals,)-513.5(population)-519.4(management,)-522.8(comparative)-519.3(evaluation,)]TJ
T*
[(and)-574.7(ongoing)-572.3(quality)-579.5(improvement.)-573.5(In)-578.1(addition,)-578.3(VBH)-576.3(is)]TJ
0 -1.1174 TD
[(utilizing)-357.3(Vermonts)-358.6(All-Payer)-358.7(Claims)-361.4(Database)-359.9(\(APCD\))-360.5(to)]TJ
0 -1.1116 TD
[(evaluate)-353.5(outcomes)-352.1(and)-350(to)-347.9(support)-353.2(ongoing)-347.7(data-guided)-355.7(im-)]TJ
T*
[(provement)-267(with)-264.7(products)-263.3(such)-264.6(as)-262.4(practice-level)-270.5(proles)-267.8(with)]TJ
0 -1.1174 TD
[(comparative)-444.5(results)-440.7(for)-441(a)-445.8(set)-436.4(of)-445.7(standardized)-444.1(expenditure,)]TJ
0 -1.1116 TD
[(utilization,)-335.4(and)-332.8(quality)-337.6(measures.)]TJ
1.0137 -1.1116 TD
[(O)15.3(v)16.2(er)25.5(a)15(l)0(l)26.3(,)-377.8(t)16(h)0(e)-366.2(B)15.2(lu)26.5(e)15(p)0(r)26.6(i)0(n)26.5(t)-375.6(mo)25.4(d)16.2(e)0(l)-366.4(i)16(s)-381(m)15(o)16.2(s)0(t)-365(d)16.2(ir)26.5(ec)24.3(t)16(l)0(y)-365.2(d)16.2(es)25.6(ig)26.5(n)16.2(e)0(d)-366.2(t)16(o)]TJ
-1.0137 -1.1174 TD
[(i)16.1(m)15(pr)26.6(ov)26.6(e)-480.3(t)16(h)16.2(e)-480.3(ra)25.5(t)16.1(e)-480.3(a)15(t)-479.3(w)15.3(h)0(i)26.5(c)15(h)-479.1(t)0(h)26.5(e)-480.3(g)16.2(e)15(ne)25.4(r)16.2(a)0(l)-464.3(p)0(o)26.6(p)0(u)26.6(l)16.1(at)25.3(io)26.5(n)-479.1(r)16.2(e)15(c)0(e)24.3(i)0(v)26.5(e)15(s)]TJ
0 -1.1116 TD
[(r)16.2(e)0(c)24.3(o)16.2(mm)24.1(e)15(n)0(d)26.6(e)15(d)-243(p)0(r)26.6(e)0(v)25.4(e)15(nt)26.5(iv)26.5(e)-244.2(s)0(e)25.6(r)16.2(vi)26.5(c)15(e)0(s)-233.6(i)16.1(n)-248.8(t)16(h)16.2(e)0(i)25.3(r)-243(co)25.4(m)15(m)0(u)25.4(n)16.2(it)26.3(ie)25.3(s)-242.8(a)0(n)25.4(d)-243(t)16(o)]TJ
T*
[(r)16.2(e)0(d)25.4(u)16.2(ce)-373.1(t)16.1(h)0(e)-372(r)16.2(a)15(t)0(e)-372.1(o)16.2(f)-381.2(u)0(n)26.6(n)0(e)25.4(c)15(es)25.6(sa)25.6(r)16.2(y)-387(a)15(c)15(u)0(t)26.5(e)-382.4(c)15(a)0(r)25.5(e)-382.4(se)25.6(rv)26.6(i)16.1(c)0(e)24.3(s)-381(\(e)25.5(g)16.2(,)-383.6(ho)26.6(s)16.4(-)]TJ
0 -1.1174 TD
[(p)16.2(i)0(t)26.3(a)15(li)26.3(za)24.3(t)16.1(i)0(o)26.5(n)16.2(s,)-373(em)24.2(e)15(r)0(g)26.6(e)15(nc)25.4(y)-387(d)16.2(ep)25.4(a)15(r)0(t)26.5(m)15(en)25.4(t)-387.1(v)16.2(is)26.7(i)16(t)0(s)26.7(\))0(,)-373.1(a)-388.2(g)16.2(o)0(a)25.4(l)-387.1(p)16.2(r)16.2(o)0(p)26.6(o)0(s)26.8(e)15(d)]TJ
0 -1.1116 TD
[(b)16.2(y)-467.6(Ko)25.7(o)16.2(p)-473.4(a)15(n)16.2(d)-473.4(c)15(o)16.2(l)0(l)26.3(e)15(ag)25.4(ue)25.4(s)16.4(.)-470(Ad)25.7(d)16.2(i)0(t)26.3(i)0(o)26.5(n)16.2(al)25.3(l)16.1(y)0(,)-459.5(v)16.2(i)16.1(a)-474.6(t)16.1(h)16.2(e)-468.8(A)0(P)25.9(C)0(D)24.7(,)-470(t)16.1(h)16.2(e)]TJ
T*
[(B)15.2(l)0(u)26.5(e)15(pr)26.6(in)26.5(t)-283.5(p)16.2(ro)26.6(v)16.2(i)0(d)26.5(e)0(s)-273.9(a)15(n)-283.3(o)16.2(pp)26.6(o)16.2(r)0(t)26.5(u)0(n)26.6(i)16.1(ty)-273(t)16.1(o)-283.3(e)15(v)0(a)25.4(l)16.1(ua)25.4(te)-268.4(th)26.5(e)-284.5(r)16.2(el)25.3(at)25.3(i)16.1(o)0(n)26.6(s)0(h)26.8(i)16(p)]TJ
T*
[(b)16.2(e)0(t)25.3(w)15.3(ee)24.3(n)-340.9(c)0(h)25.4(a)15(ng)26.6(in)26.5(g)-340.9(p)0(a)25.4(t)16.1(te)25.3(rn)26.6(s)-340.7(o)0(f)-330.5(u)16.2(ti)26.3(li)26.3(z)15(a)0(t)25.3(i)0(o)26.5(n)-340.9(an)25.4(d)-340.9(e)0(x)25.4(p)16.2(en)25.4(di)26.5(t)16.1(u)0(r)26.6(e)0(s)-331.5(a)15(s)]TJ
0 -1.1174 TD
[(V)15.3(B)15.2(H)-324.5(d)16.2(e)15(l)0(i)26.3(v)0(e)25.4(r)16.2(y)-323.6(s)16.4(ys)26.8(t)16(e)0(m)-309.8(r)16.2(ef)25.5(o)16.2(r)0(m)25.4(s)-317.7(ex)25.4(pa)25.4(n)16.2(d)-323.6(a)15(c)15(r)0(o)26.6(s)0(s)-307.1(V)15.3(er)25.5(m)15(o)0(n)26.6(t)0(.)]TJ
/F3 1 Tf
8.9663 0 0 8.9663 310.8472 127.8991 Tm
(Methods)Tj
/F4 1 Tf
9.843 0 0 9.843 320.8251 111.4582 Tm
[(This)-449(study)-454.7(was)-454.4(based)-451.1(on)-451.5(inpatient)-456.3(utilization)-458.7(measures)]TJ
-1.0137 -1.1174 TD
[(constructed)-436.1(from)-437.5(Vermonts)-439.3(APCD,)-436.7(which)-439.6(includes)-437.4(eligi-)]TJ
0 -1.1116 TD
[(bility)-393(and)-390.4(claims)-390.4(data.)-396.2(Vermont)-391.2(law)-391.4(requires)-396.9(collection)-395.2(of)]TJ
T*
[(data)-312.1(on)-307.5(Vermont)-310.6(residents)-317.3(from)-305.1(commercial)-317.9(health)-308.7(insurers)]TJ
0 -1.1174 TD
[(and)-586.2(Vermonts)-594.8(Medicaid)-595.2(program.)-589.5(For)-590.6(the)-592.1(purposes)-591.3(of)]TJ
0 -1.1116 TD
[(APCD)-427.5(data)-427.3(collection,)-427.4(the)-425.1(denition)-426(of)-428.4()50.8(health)-425(insurers)46.9()]TJ
/F3 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(EVALUATING)-341.1(DELIVERY)-335.2(REFORM)-336.3(INITIATIVES)-31500.2(7)]TJ
ET
endstream
endobj
58 0 obj
<>stream
hlT{Pr!֥W,""3䥂t$"]`UKv萊R 5ئ8%vV1aIu~ktwqv"*jftdL0alu<