Question

Policymakers give many recommendations that can improve the efficiency of the U.S. health care system. Which recommendation do you think can be the game-changer for U.S. health care?

Answer 1

Recommendation: The committee recommends that the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) seek additional funding to expand its research to include substantial support for high-quality studies that would allow a broad approach more closely linking scientific and technological advances to clinical trials, outcomes research, and health services research more generally. Although some of the required research is of the sort currently funded by the Agency for Health Care Policy and Research (AHCPR), there is much to be said for bringing fundamental experimental research, clinical trials, and services or outcomes research on rheumatic disease under one roof, so that the benefits of a more coherent and unified approach might be realized. For example, studies might look at the way new technology is assessed and implemented in various types of managed care organizations and the rate of penetration and prevalence of application of medically accepted new technology in various types of managed care organizations.

Recommendation: Studies of clinical interventions, health care delivery systems, and clinical course and outcomes should examine clinical, demographic, ethnic, and other subsets of patients with RA and SLE.

Recommendation: Method of payment, medical specialty of the provider, and initial health and socioeconomic background of the patient subjects should be carefully controlled in future studies or, preferably, studied in their own right, and measures of health status and function should be included in addition to simply noting the interventions provided.

Recommendations: The incorporation of these clinical and social interventions into different health care delivery systems should be another area of research for NIAMS. In fact, the availability of such interventions would have to be considered in any evaluation of quality of care. Other research should focus on how these interventions might be improved and extended. For example, how can poorer, less educated patients and patients from different ethnic or cultural backgrounds be persuaded to take a more active role in the management of their rheumatic disease? Would ''patient report cards'' or more explicit planned feedback from provider to patient make RA or SLE patients more effective team members in management of these diseases?

Recommendations: The incorporation of clinical and social interventions into different health care delivery systems should be another area of research for NIAMS. In fact, the availability of such interventions would have to be considered in any evaluation of quality of care. Other research should focus on how these interventions might be improved and extended. For example, how can poorer, less educated patients and patients from different ethnic or cultural backgrounds be persuaded to take a more active role in the management of their rheumatic disease? Would ''patient report cards'' or more explicit planned feedback from provider to patient make RA or SLE patients more effective team members in management of these diseases?

• Managed care is a powerful and still growing element of U.S. health care, although it is a heterogeneous movement the final form or forms of which are still evolving.
• Chronic disease is responsible for a large and growing proportion of health care utilization in the United States today, but those suffering from these diseases are also highly heterogeneous.
• The growth of both managed care and chronic disease have cast work force issues into bold relief, demanding reanalysis of the optimal roles of generalists and subspecialists.
• The interaction of managed care and chronic disease is a complex nexus that requires new research paradigms, which should be as integrative as possible.

• The trends that will increasingly impact multiple healthcare stakeholders over the next few years (through 2018) include:

• Patients becoming more informed consumers

• Growth of structured quality measures

• Revenue-driving consolidation

• New and alternative provider payment models

• Specialty drug use driving the cost of care

• Information technology innovations driving interstakeholder communications.

• Patients as Consumers Making More Informed Healthcare Choices

  The old healthcare model of treating acute illnesses is evolving into a model with increasing focus on the patient, disease prevention, and the ongoing management of chronic diseases. Today's healthcare market allows consumers to take charge of their healthcare in a new way. Readily accessible data and information allow patients to have open dialogues with their doctors about diagnosis and treatment options. Cost estimators increasingly help consumers understand the intersection of cost and quality in assessing their care options. Market exchanges for health insurance let people choose from a large variety of insurance coverage plans and options.

• Growth of Quality Measures Increases, Becoming More Structured

  Reported by many sources since 2010, the United States spends more on healthcare than any other industrialized country; however, the US healthcare system is not better, and its quality is inconsistent. One reason for this is that the healthcare system is primarily fee for service (FFS), in which providers receive payment for each service rendered, leading to incentives to provide more, not better, services.

• Revenue Pressure Driving Healthcare Stakeholder Consolidation

  A fundamental shift in healthcare economic risk is taking place, driven by an aging population and the increasing incidence of behaviorally induced chronic conditions. Health systems, which include people, institutions, and resources that deliver healthcare services to meet the health needs of target populations, are evolving with the market and delivery innovations to meet the challenge of managing healthcare risk through a growing emphasis on primary care, integrated care models, and pay-for-value reimbursement.

• New and Alternative Provider Payment Models

  New provider payment models are emerging as increased cost pressures are driving payment models away from FFS approaches to those that better align incentives for cost control and high-quality delivery of patient care.