The emergence of new payment models and value-based care has forced health care providers to reconsider their value proposition. To retain market share and enhance their contracting position, providers must improve their quality and efficiency and increase patient outcomes. Only those providers with a clear value-based agenda can compete and thrive in this new environment. Health care providers that fail to embrace value-based care will face increasing pressure and loss of subscribers to more value-oriented organizations.
In a nutshell, the goal of quality measurement in health care is to identify the health outcomes that patients care for. These outcomes should be based on the medical condition being treated and should track the health status of the patient after the treatment. There are three main types of health outcomes: functional status, mortality rates, and quality of care.
Health care services are provided by the government and the private sector. There are two main branches of government: the judicial and the administrative. The judicial branch is responsible for interpreting laws related to health care. It also regulates the number of health care workers and reimbursement for the services rendered. In addition to setting health care policy, the administrative branch oversees the implementation of various health care programs. However, the private sector has a substantial influence on these policy decisions.
In the mid-twentieth century, physicians enjoyed considerable autonomy. In the sociological literature on professions, physicians were often used as an example of a full professional. Their role was assumed to be in the best interest of the client, as a result of an altruistic service orientation. The motto for the businessperson, on the other hand, was caveat emptor. This contrast illustrates the disparity between social expectations for business and professions.
In a multidisciplinary team, several clinicians work together to treat the patient. Their role is to take responsibility for the full cycle of care, including education and engagement. Dedicated facilities are used to coordinate care. The physicians are the captains of the team, and the team meets regularly. These teams are accountable for the outcome and the cost of care.
Taking a holistic approach to health care is essential in creating a value-based health care delivery system. It starts with determining the overall scope of services and reducing service lines that don’t yield high value. This will enable academic medical centers to enter into partnerships or affiliations with lower-cost community providers.
Access to quality health care is essential to achieve health for all. It requires skilled health workers, adequate funding and adequate resources. Governments and health policy makers have committed to providing universal health coverage. However, this coverage must be based on strong primary care. A health system should also focus on preventing disease and enhancing quality of life.
Many providers are nervous about bundled payments, and worry that their patients won’t be treated according to their preferences. In addition, they are concerned about lack of accurate data regarding costs at the condition level. However, these concerns will fade away as the technology improves and as the evidence mounts that providers have an economic interest in aligning payment with value. If a bundled payment model is able to meet their needs, they will increasingly adopt it.