Health care is a wide spectrum of medical practices, procedures, treatments, and equipment designed to maintain or restore physical, mental, and emotional well-being. It involves both clinical and nonclinical processes, including the interaction of patients and providers.
A health system is a comprehensive set of institutions, programs, and resources that deliver and coordinate essential health services. This includes hospitals, clinics, home healthcare agencies, and other providers. It is a complex system that combines multiple disciplines, such as physicians, nurses, social workers, and pharmacists, into an integrated team.
The primary goal of health systems is to improve the health of individuals and populations. This can be done by providing access to essential services, reducing preventable diseases, and improving patient outcomes.
In the United States, the cost of health care is a significant factor in determining whether individuals and families can obtain coverage. While the number of uninsured has declined in recent years, a high rate of uninsured remains. People without insurance are more likely to delay care until their condition becomes life-threatening or to seek it from providers who offer services at subsidized rates.
To increase coverage, policymakers must address the growing cost of health care and develop policies that allow those who cannot afford to pay for their own coverage to purchase it. Moreover, they must ensure that policies do not have a negative impact on the quality of health care and the patient experience.
A value-based system aims to improve value by organizing health care around the patient’s medical need and delivering high-quality, efficient, cost-effective care. To achieve this, a shift must be made from siloed organizations that are organized by specialty and service line to organizational structures that focus on the patient’s medical need. These organizational changes are referred to as integrated practice units (IPUs).
IPUs must incorporate the core functions of patient care, such as addressing symptoms and making referrals to other clinicians. They also must integrate nonclinical components, such as information technology and management of financial resources. IPUs must track performance and outcomes in a way that aligns with the delivery of care.
In addition, a value-based system must ensure that the costs of care are transparent and equitable to patients. Those costs must be determined through an objective process that considers the cost-effectiveness of different options, as well as the benefits gained by increasing access to care.
These costs must be reflected in the price that health insurers charge to subscribers. As a result, bundled payment models will have an important role to play in helping to determine a provider’s economic competitiveness.
For community and academic health systems, integrating systems of patient-centered and integrated care may require a variety of strategies to address the challenges of resource and capacity constraints. It may mean eliminating certain service lines that cannot be realistically achieved through value-based arrangements or establishing partnerships with lower-cost community providers in those areas.
A value-based system must also be designed to accommodate the needs of vulnerable populations and to avoid discrimination based on race, ethnicity, and other factors that have historically been disadvantageous in the health care sector. It must consider the latest scientific data and best practices in health care. It must also monitor and adjust its policies in light of those scientific advances, ensuring that it does not discriminate against vulnerable patients or groups.