It’s generally understood that addressing the quality and cost challenges in today’s healthcare environment will require removing incentives that favor intervention over outcomes. Though the jury is still out on which emerging payment and delivery models will replace what we’ve known, it’s critical to recognize that we are in the midst of a redefining transition, and the gap between what’s needed and what most systems can deliver is wide. Those organizations that wait for the new model to be defined will struggle to survive, but making changes now can yield favorable financial and clinical results, even in the fee-for-service world.
Many executive teams are unsure of what to do next. ACO, PCMH, PFP, and other acronyms abound, and terms like population health, value-based purchasing, and bundled payment are given a variety of meanings. Regardless of the organizational structure or payment mechanism, the mandate is clear: improve health and outcomes for individuals and populations with the right care – delivered at the right time, in the right setting, by the right provider – while maintaining a focus on the patient, coordinating across the continuum, and reducing cost. It’s a tall order, and not every organization will rise to the challenge.
Transforming healthcare delivery is neither quick nor painless, and it requires progress on many fronts. EMRs and other IT systems are important enablers, but they aren’t enough on their own. Data and clinical evidence are critical as well, but won’t translate into results without appropriate accountabilities, financial and clinical integration, and cultural shifts. Leaders will have to improve communication and collaboration, ensuring all parties involved in care delivery can see the full picture and have aligned incentives. They will also need to consider new partnerships, new technologies, and new quality measures.
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