Five Value-Based Health Care Systems

health care

While all countries have some combination of these five models, they tend to vary between them. The amount of money spent on health care is a critical question, and it is typically expressed as a share of GDP. OECD countries show that spending on health care correlates with longer life expectancy. However, life expectancy is not a single, objective measure of health system performance. Thus, it is important to note that more funding does not necessarily translate to higher health outcomes.

The first step in achieving a higher quality care system is to change the way providers organize clinical care. Traditionally, health care providers have organized around their own needs and clinical indicators. To make a truly value-based system, organizations need to shift away from silos and toward patient-centered care. One way to achieve this is to form an integrated practice unit, a health care unit comprised of clinical and nonclinical personnel. As a result, providers can more effectively measure what matters to their patients.

A multidisciplinary team of clinicians devotes significant time to each patient’s medical condition. The multidisciplinary team integrates education and engagement in the patient’s care. In this model, the patient receives a seamless, comprehensive service from multiple health care providers. The team also uses a single administrative structure and schedule, and co-locates care in dedicated facilities. The physician captain of the team oversees the care process. This model allows clinicians to focus on treating the patient rather than merely evaluating and managing symptoms.

The key to achieving a value-based health care system is system integration. The process begins with defining the overall scope of care services. Next, service lines must be consolidated and reduced. Community providers may exit expensive service lines, while academic medical centers may form affiliations with lower-cost community providers. Ultimately, the goal is to move from a fee-for-service reimbursement model to a value-based one. However, this transition will likely take time.

While the Affordable Care Act will remain in place until 2020, some of its provisions may be repealed. For example, the Trump administration will remove the individual mandate from the law in 2019, and allow states to offer lower-cost, minimally regulated health insurance plans. This will undoubtedly lead to higher premiums for many Americans, and the federal government will be forced to limit health care coverage for the poorest workers. However, there are positive steps on the horizon, and the Trump administration has already begun implementing some of these measures.

The underlying problem is that many organizations are failing to realize their true objective. While they may have a noble mission statement, their primary focus is still growing volumes and maintaining margins. By failing to realize their ultimate goal, these organizations are only doing themselves a disservice and will soon find themselves unable to compete. And health insurers that do not support this shift will ultimately lose subscribers to high-value providers. That is not the way to make money in health care.

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