Transformation of Health Care—Perspectives of Opinion Leaders

Joanne  Disch; Thomas W. Feeley; Diana J. Mason; Richard L. Schilsky; Ellen L. Stovall; Shelley Fuld Nasso

Article | Seminars in Oncology Nursing | May 2016

Transformation of Health Care—Perspectives of Opinion Leaders

by Joanne Disch, Thomas W. Feeley, Diana J. Mason, Richard L. Schilsky, Ellen L. Stovall and Shelley Fuld Nasso

Abstract

"What Health System Transformations Do You Believe Are Necessary for the Future of Health Care?" We need to transform to a true value-based health care delivery system. That means organizing care around medical conditions, not simply around hospitals and doctors. We need to do more team-based medicine and to better integrate specialty care with primary care. We need to be doing a better job measuring health outcomes that matter to patients, which includes patient-reported outcomes and clinician-reported outcomes. These need to be used for internal improvement in health care delivery organizations, as well as for public reporting, so that patients can make informed choices about their health care. We need to do a better job measuring, reporting and controlling the costs of health care so that our economy can improve and so that patients can make informed decisions. We must move away from fee-for-service reimbursement, which incentivizes doing more, and begin paying for good outcomes. Health care organizations need to stop duplicating every service and have centers of excellence with high-volume experts. Finally, we need better health information technology systems to facilitate knowledge transmission and communication.

Keywords: Perspective; Health Disorders; Performance Improvement; Health Care and Treatment; Transformation; Health Industry;

Format: Print

Citation:

Disch, Joanne, Thomas W. Feeley, Diana J. Mason, Richard L. Schilsky, Ellen L. Stovall, and Shelley Fuld Nasso. "Transformation of Health Care—Perspectives of Opinion Leaders." Seminars in Oncology Nursing 32, no. 2 (May 2016): 172–182.

Since its establishment in 2005, Hamburg’s Martini Klinik had single-mindedly focused on prostate cancer care with a commitment to measure long term health outcomes for every patient. A wholly owned subsidiary of the University Hospital Hamburg, Martini Klinik was a “hospital in a hospital” in close proximity to other medical departments and services. By 2019, Martini Klinik had become the largest prostate cancer treatment program in the world with 8,000 outpatient cases and more than 2,500 surgical cases annually. Patients came from all over Germany and from around the world. A new and expanded facility was under construction to have the capacity to manage more patients with prostate cancer.

At one point or another in our life, we all become consumers of the health care industry. Indeed, health care affects everyone and encompasses a diverse set of services from childbirth, to illness prevention, to the management of chronic disease and end-of-life care. Health care in the United States is executed through a complex set of interrelationships between three distinct parties: payers, providers, and consumers. Each group has its own perspective accompanied by a set of unique incentives, which complicate the adoption of a value-based health care system. To transform the American health care delivery system, all participants including patients, physicians, employers, insurance companies, and the government need to recognize that value is best defined as “a given health outcome per dollar of cost expended.” In this article, we examine some of the challenges to creating and implementing a value-based health care system against the backdrop of a turbulent industry and consider the implications for the anesthesiologist.

Article | NEJM Catalyst | November 8, 2018

Transitioning Payment Models: Fee-for-Service to Value-Based Care

Thomas W. Feeley and Namita Seth Mohta

In a survey of the NEJM Catalyst Insights Council in July 2018, 42% of respondents say they think value-based reimbursement models will be the primary revenue model for U.S. health care. Indeed, this transition is already happening. Respondents report that a quarter of reimbursement at their organizations is based on value, on average. While three-quarters of their revenue remains fee-for-service, we see a remarkable change to a reimbursement system that was static for decades. In particular, survey respondents’ organizations are pursuing two value-based strategies: accountable care organizations, which often use capitated payments, and bundled payments. Nearly half (46%) of respondents say value-based contracts significantly improve the quality of care, and another 42% say value-based contracts significantly lower the cost of care. The survey identifies the leading barriers to implementing value-based reimbursement models. Infrastructure requirements, including information technology (indicated by 42% of respondents), and changing regulation/policy (34%) are the top two. There is strong consensus on the broad metrics that are most important for measuring value-based care. Outcome measures top the list, with 60% of respondents saying they are extremely important. This survey suggests that many in health care see value-based reimbursement as a real solution to the nation’s current health care crisis.

Keywords: payment methods; value-based healthcare reimbursements; Health Care and Treatment; Value; Transformation;

Citation:

Feeley, Thomas W., and Namita Seth Mohta. "Transitioning Payment Models: Fee-for-Service to Value-Based Care." NEJM Catalyst (November 8, 2018). View Details

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