Question

Can you suggest some important elements that must be present in a future model of care delivery in the United States? 75-100 word.

Answer 1

The health care sector in the United States consists of an array of clinicians, hospitals and other health care facilities, insurance plans, and purchasers of health care services, all operating in various configurations of groups, networks, and independent practices. Some are based in the public sector; others operate in the private sector as either for-profit or not-for-profit entities. The health care sector also includes regulators, some voluntary and others governmental. Although these various individuals and organizations are generally referred to collectively as “the health care delivery system,” the phrase suggests an order, integration, and accountability that do not exist. Communication, collaboration, or systems planning among these various entities is limited and is almost incidental to their operations. For convenience, however, the committee uses the common terminology of health care delivery system.

multiple approaches to delivery system reform may be necessary to bend the cost curve and improve care quality. For example, the effectiveness of a single disease management program may be limited for patients who have multiple chronic conditions and who require coordinated care from many specialists. Moreover, efforts to coordinate care will be less effective without the use of electronic medical records and more comprehensive decision support for both patient and provider. Alone, sophisticated HIT systems will be ineffective if providers do not have payment and other incentives to promote systematic coordination of care. Finally, providers will not be as successful as they can be over the long term if they have do not have access to practical evidence on which clinical practices work best in particular cases or which patients need timely interventions. Evaluations of past efforts to integrate delivery system reforms show promising results. Delivery system reforms must be implemented in concert with other reforms to provide the tools, resources, and incentives (for patients and providers) needed to assure better patient outcomes.

Reforming health care payment and delivery and expanding coverage are not only complementary; each is critical to achieving the other. Coverage expansion is critical to fully address the underuse of effective care, a problem that is particularly severe among the uninsured. At the same time, successful payment and delivery reform is needed to increase the value of health care, with better quality care and slower cost growth. These improvements will likely induce more Americans to purchase health insurance coverage as it becomes more affordable and valuable. Modeling results presented in this paper predict that if delivery system reforms can help achieve reasonable increases in value, millions of additional Americans could obtain health insurance coverage by 2019, even absent expansions in coverage. Of course, delivery system reforms alone will not ensure universal coverage; major steps must be taken to explicitly ensure coverage for every American. Yet substantial progress toward effective delivery system reform is critical to achieving goals with respect to expanded coverage.

These findings have several implications for policy actions by Congress and the Administration:

• Lead with Medicare by implementing a clear vision for transitioning payments to promote greater accountability for improving the value of health care. Efforts to promote delivery reform that do not include Medicare cannot have a major impact on the environment of medical practice.
• Develop and promote the consistent, meaningful use of valid and widely available information on the quality and cost of health care, with a particular emphasis on measuring health outcomes and overall costs at the level of episodes of care and at the level of individual patients. This includes using HIT systems to simplify data collection and reporting, and building better evidence on which delivery approaches best work.
• Promote an integrated approach to delivery reform by giving providers a feasible pathway for organizing local delivery systems around the principle of accountability. Simultaneously work to (1) implement and continually improve HIT and quality measurement infrastructure, (2) provide better systems for the coordination of primary care and the delivery of preventive care, and (3) introduce new payment systems to support reductions in cost growth and improvements in quality.
• Encourage efforts at the state and regional levels to enable public and private payers, including Medicaid and Medicare, to participate in private-public initiatives aimed at using better, outcome-focused performance measures to support payment and benefit reforms that promote accountability for greater value.