Payors are aggressively reducing reimbursement and moving towards a more value-based system. While Medicare and Medicaid reimbursement rates continue to grow, they still represent a relatively small portion of overall health expenditures. Furthermore, the pressure to contain costs is driving independent hospitals to join health systems, and physicians to become salaried employees of hospitals. As a result, the transition from a fee-for-service system to a global capitation system will likely take years.
To truly integrate health care systems, the scope of services must be clearly defined and service lines must be merged. Relocating services within a health system can be tricky, particularly given the politics of redistributing service lines. Most providers will instinctively protect their turf and preserve the status quo. Boards should ask questions about the transformation process and the need to rethink the current service lines. In the end, the transformation of health care requires a more value-based system.
There are two main challenges facing health care: a lack of clarity about the end-goal, and the pursuit of the wrong goal. A narrow focus on reducing cost and increasing volume will stymie health care reform. The wrong goal is to maximize profits and not improve outcomes. The current model of payment structures and delivery approaches has little alignment with the needs and interests of patients. The current reimbursement model based on volume and cost is not a sustainable business model.
A sound bundled payment model will incorporate features of a value-based system. Among these are severity adjustments and eligibility only for those patients who qualify for the services. Moreover, it will include care guarantees that will hold providers accountable for avoidable complications like infections after surgery. Lastly, it will also include mandatory outcomes reporting for all patients. In other words, bundled payment models will improve quality and efficiency in health care. In short, a bundled payment model will improve value and reduce cost by as much as 50%.
The government monopoly over health care financing and provision means that the allocation of resources is less efficient than it would be in a market. While the current U.S. health care system provides some benefits, it is not a true model of a private market health care system. Furthermore, taxes and regulations in the U.S. are one of the major causes of the high cost of health care. Moreover, government-controlled health care systems will not provide universal coverage.
In the United Kingdom, the National Hospital for Neurology and Neurosurgery is a neurological hospital that offers a range of services to its patients. Allied health professionals provide services in the community and residential settings as well as long-term care and treatment of substance use disorders. It is a complex system that requires an understanding of its components. If patients do not understand the differences between health care facilities, it may be difficult to make informed decisions when it comes to medical care.
Value-based health care requires a significant shift in the clinical organization. The first principle of structuring any organization is to organize around the needs of the customer. This means moving from a siloed, specialized approach to a patient-centered approach. An integrated practice unit is a good example of this. These units are composed of clinical and nonclinical personnel, which work together to ensure the best possible care. It is important to measure these outcomes to improve health care in the U.S.