TO ADVANCE HIGH-VALUE CARE
The items in this Checklist reflect core elements for the health care transformation needed to deliver high-value care—better outcomes at lower costs. On the other hand, many of the levers for true transformation lie outside the control of institutional leaders and in the domain of broader, system-wide policies and incentives. In many ways, we are operating in a time of turbulent optimism. Recent legislation and changes in the health care marketplace afford numerous opportunities for change, but systemic barriers to successful transformation remain.
Reference has already been made to the challenges faced by each of us at die individual and institutional levels, and the challenges to the efficient operation of the system as a whole. In addition, prevailing system-wide payment models have placed an economic disincentive on adopting some of the cost-containment strategies outlined above. In a system that rewards volume over value, many health care delivery organizations have invested in expensive technologies and equipment, hired unnecessary personnel, and expanded their brick-and-mortar operations. This kind of overcapitalization creates an economic incentive to maximize revenue from capital that has already been invested, rather than seek out opportunities to reduce costs and improve quality. Few institutions have been spared the consequences of this phenomenon, including our own, but working to address it is a very real mandate, and a core motivator of our interest in sharing experiences on ways to improve. Most fundamental to enabling the transition envisioned is the alignment of incentives and operations to reflect the principles of high-value care. Patients, and employers who share in paying for their care, should be provided information and incentives to seek out institutions that provide high-value care, and delivery sites should be reimbursed in accordance with the value of care delivered.
Patients, and employers who share in paying for their care, should be provided information and Incentives to seek out institutions that provide high-value care, and delivery sites should be reimbursed in accordance with the value of care delivered.
Faced with die extreme consequences of growing costs, many purchasers are beginning to leverage their power to demand high-value care. Employers are attempting to rein in health care costs by contracting with providers and insurers, redesigning benefit plans, and providing incentives and information to employees. Individuals, too, are increasingly looking to contain health care expenditures. Mounting costs for individual coverage as well as cost-sharing/shifting in group plans have increased consumer discretion. While this shift is already under way in some markets, considerable progress is still needed. Accelerating this progress revolves around increasing transparency on cost and outcomes. Only with the knowledge of which delivery sites provide the best care for the lowest cost can employers and other purchasers drive volume to institutions that provide high-value care.
Reimbursement models that favor high-value care also create an imperative