Organizing the U.S. health care Delivery SyStem fOr high PerfOrmance (original) (raw)
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Organizational Fragmentation and Care Quality in the U.S. Healthcare System
Journal of Economic Perspectives, 2008
Many goods and services can be readily provided through a series of unconnected transactions, but in health care, close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the U.S. healthcare system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations, and capabilities. These fragmented organizational structures lead to disrupted relationships, poor information flows, and misaligned incentives that combine to degrade care quality and increase costs. We illustrate our argument with examples taken from the insurance and hospital industries, and discuss possible responses to the problems resulting from organizational fragmentation.
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Fifteen case studies illustrate how diverse types of organized health care delivery systems promote higher performance through information continuity, patient engagement, care coordination, team-oriented care delivery, continuous innovation and learning, and convenient access to care. Those attributes are supported by values-driven leadership, interdisciplinary teamwork, integration and aligned incentives (both at the organizational and provider level), accountability, and transparency. Commonly reported results include improved clinical quality of care and control of chronic diseases, increased patient satisfaction, shorter waiting times, and reduced hospitalizations, emergency visits, and prescription drug expenses. The experience of these organizations supports recent recommendations by The Commonwealth Fund Commission on a High Performance Health System to stimulate greater organization of health care in the United States.
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Health affairs, 1994
Prologue: In anticipation of reforms at either the state or the national level and in response to rising costs, health care organizations are changing rapidly. "Managed care" has taken on new meanings us the lines traditionally separating hospitals, physicians, and insurers begin to blur. Policymakers struggle to define this new concept of managed care, sometimes referred to us "integrated service networks" or "organized delivery systems." These entities combine the organization, financing, and delivery of health care in wuys that respond to the demographics and economics that prevail in different regions of the country. Ultimately , the system should provide appropriate care in a seamless continuum that uses limited resources most effectively. The way these new organizational hybrids grow and develop in their early years has important implications for the health and health care of Americans for years to come. In this paper Stephen Shortell and colleagues outline their research on organized delivery systems, describe the barriers such systems face, and raise key policy questions that must be answered.
Thank you for this opportunity to present my assessment of the urgent need for health care reform. President Obama has made a forceful case for health reform, stressing the imperative of action on the goals of ensuring stability and security of health insurance coverage for those who have it, providing insurance for those who don't, and slowing the rise in health care costs for employers, families, and government. He set forth a pragmatic plan, building on what works and fixing what doesn't, while signaling his openness to the best ideas from all. Congress has taken unprecedented steps toward passing comprehensive reform that achieves these goals and moves our system down the path to high performance. As the President stressed, after a century of inaction, now is the season to act and failure is not an option. It is too important to those who are harmed by our inadequate insurance system, too important to our economy, and too important to our character as a country.
Health Care Delivery System Reform
Journal of the American College of Cardiology, 2009
Health care reform is moving forward at a frantic pace. There have been 3 documents released from the Senate Finance Committee and proposed legislation from the Senate HELP Committee and the House of Representatives Tri-Committee on Health Reform. The push for legislative action has not been sidetracked by the economic conditions. Integrated health care delivery is the current favored approach to aligning resource use and cost. Accountable care organizations (ACOs), a concept included in health care reform legislation before both the House and Senate, propose to translate the efficiencies and lessons learned from large integrated systems and apply them to nonintegrated practices. The ACO design could be real or virtual integration of local delivery providers. This new structure is complicated, and clinicians, patients, and payers should have input regarding the design and function of it. Because most of health care is delivered in the ambulatory setting, it remains to be determined whether the ACOs are best developed in parallel among physician practices and hospitals or as partnerships between hospitals and physicians. Many are concerned that hospital-led ACOs will force physician employment by hospitals with possible unintended negative consequences for physicians, hospitals, and patients. Patients, physicians, other providers, and payers are in a better position to guide the redesign of the health care delivery system than government agencies, policy organizations, or elected officials, no matter how well intended. We strongly believe-and ACC has proclaimed-that change in health care delivery must be accomplished with patients and physicians at the table. (J Am Coll Cardiol 2009;54:985-8)
Integrated Healthcare Delivery Models in an Era of Reform
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Healthcare delivery in the United States is shifting from a fragmented “cottage industry” of solo and small physician practices paid on a fee-for-service basis to more organized forms in which physicians join with other providers in efforts to improve the quality and efficiency of care. In the midst of this historic change—which is being driven by both market forces and public policy—it is useful to reexamine where the United States has come from in terms of healthcare delivery models and where the current pathways are leading. This chapter describes how models of integrated healthcare delivery have provided inspiration and ideas for recent policy reforms, and traces the evolution of such models into new and emerging ways of integrating care. Integrated Healthcare Delivery Models in an Era of Reform
U.S. Health System Performance: A National Scorecard
Health Affairs, 2006
This paper presents the findings of a new scorecard designed to assess and monitor multiple domains of U.S. health system performance. The scorecard uses national and international data to identify performance benchmarks and calculates simple ratio scores comparing U.S averages to benchmarks. Average ratio scores range from 51 to 71 across domains of health outcomes, quality, access, equity, and efficiency. The overall picture that emerges from the scorecard is one of missed opportunities and room for improvement. The findings underscore the importance of policies that take a coherent, wholesystem approach to change and address the interaction of access, quality, and cost. [Health Affairs 25 (2006): w457-w475; 10.1377/hlthaff.25.w457] S c o r e c a r d H E
Collaboration and the Quality of Health Care Delivery
2008
It is generally recognized that health care delivery in advanced societies is under severe strain from multiple sources including accelerating and interrelated increases in technological sophistication, quantity and specialization of knowledge, patient awareness and assertiveness, cost pressures, and societal demands for accountability. Most proposals for reform concern one or another piece of this complex: technological fixes, improved protocols, efficiency increases, cost controls, patient information, pay for performance, and many more. But all these piecemeal reforms have run into major obstacles. Doctors have often been reluctant to adopt new procedures, especially when standardized; cost control has been portrayed as compromising the quality of care; conflicts have grown between insurance companies and care providers. The outcomes have generally been poor on both quality and cost measures, with a failure to master the complexity of the conflicting demands, and growing dissatis...