Quality measurement in health care has traditionally centered on the least controversial measures. Most of these metrics do not actually gauge quality but capture compliance with practice guidelines. For example, providers of diabetes care measure the accuracy of LDL cholesterol checks and hemoglobin A1c levels. Patients, on the other hand, care more about the risk of blindness, dialysis, and amputation. In this article, we examine how health care quality metrics can be used to improve patient care.
Although we can’t blame physicians for these mistakes, we can identify the most significant factors that drive their performance. Tight physician fee schedules give physicians incentives to cut down on the time they spend with patients. Patients have to visit several doctors before receiving the same care. These hidden costs do not appear in standard measures of health care spending. But these costs are substantial, and we should not overlook them. So, what can we do to improve the quality of health care in the United States?
The Affordable Care Act (ACA) is a major component of health care policy in the United States. Its expansion under the Affordable Care Act is largely tax-funded, with only state and local revenues accounting for the rest. Medicaid, for example, was fully funded by the federal government until 2017, but its federal funding has since decreased to ninety percent. CHIP, meanwhile, is funded by matching grants to states. In exchange for these grants, most states also charge premiums under the program.
Despite the need for cost transparency, health care organizations are still flying blind in their efforts to improve the value of care. Without proper cost data, clinicians and administrators struggle to collaborate, resulting in arbitrary cuts and inefficiency. The solution lies in cost-effectiveness. The system must be able to calculate true costs of care at the medical condition level and track costs throughout the entire cycle of care. Then, clinicians and administrators can compare the cost of a condition to the outcomes it achieves.
Value-based health care delivery requires a fundamental change in the way care is delivered. Provider organizations must embrace new payment models and improve patient outcomes, which will sustain their market share and help them win better contracting positions. Those that succeed will be the most competitive in the future. If health insurers do not support the value agenda, they will risk losing subscribers to those who provide quality care at an affordable price. When that happens, the benefits of health care reform will outweigh any costs.
Moreover, access to a health plan increases health outcomes. Health insurance is a necessary requirement for most Americans. This could either be a private plan or a government-funded program. It is well-established that health insurance leads to better health outcomes for adults, including better access to preventive care, early detection, and treatment of chronic illnesses and injuries. In addition, the availability of health care insurance has a positive effect on the quality of life and prevents 18,000 premature deaths every year.