Health Care Reform: The Strategy


Every healthcare system worldwide is struggling with rising costs and uneven quality. Despite measures to fix this problem, such as enforcing practice guidelines, implementing electronic medical records, and reducing errors, none have been successful. There is a need to implement a new strategy that maximizes value for patients and helps achieve the best outcomes at a low cost. This article looks at health care reform strategies that can improve patient outcomes.

Value enhancing platforms

A value-enhancing platform is centred on patients and encompasses a lot of patient data. Health Insurance Introduction looks to integrate care delivery systems for individual patients. It starts with defining service scope, choosing the right location, and integrating care across sites. In most cases, health care reform involves several interdependent and mutually reinforcing components vital to obtaining health coverage and meeting health care reform requirements. Health insurers who are slow to embrace and support the value agenda may lose subscribers to those that do. The strategy requires employers to make affordable coverage available to their full-time employees or pay the penalty.

Defining the goal

The healthcare reform strategy starts with defining a goal and having clarity to achieve it. The primary objective of healthcare reform is to reduce the number of uninsured, make healthcare more affordable, and improve the quality of care. Their overarching goal is to enhance value for patients defined in the form of health outcomes achieved no matter the cost. Improving this value entails improving healthcare provision without raising expenses or lowering costs without compromising results.

The strategy for value transformation

In most cases, health organizations are concerned with improving volumes and maintaining margins without enhancing the outcomes. This needs to change due to the severe pressure to contain costs and move towards performance-based reimbursement from fee-for-service.

There should be a switch from the fragmented system where local providers offer a full range of services to a system where healthcare services are concentrated in the right location to deliver high-value care. Another strategy is to move away from the supply-driven Healthcare system organized around physicians toward a patient-centered approach organized around patients’ needs.

The strategy should also shift focus from the profitability of service provided to patient outcomes. For example, we should not focus on the volume of services offered in tests, physician visits, or procedures. This transformation requires an overarching strategy of restructuring the organization, measurement, and reimbursement of healthcare delivery.

Organizing into integrated practice units

The core strategies to maximize value transformation entail changing how clinicians are organized to deliver care. It starts with structuring the organization or business by organizing around the customer and their needs. In healthcare, this may require changing from the siloed organization by specialty department to organizing around the patient’s medical condition. This integrated practice unit structure involves a dedicated team of clinical and non-clinical personnel providing complete care for patients’ conditions.

The integrated practice unit structure provides treatment and assumes responsibility for engaging patients and their families. For example, it can encourage adherence to treatment and prevention protocols while supporting behavioral changes. In the structure, personnel regularly work together toward a common goal to maximize patient outcomes and efficiency. They coordinate easily to help minimize the waste of time and resources and devise better ways to engage patients.

Measuring the cost of care

Providers need a strategy that transcends the traditional cost reductions and responds to new payment methods. If a healthcare provider can improve patient outcomes, there is an opportunity to sustain or grow their market share. Improving the efficiency of providing care can also allow physicians to enter contract discussions from a position of strength. It means those providers who increase value are more competitive, while those who fail to improve value encounter growing pressure.

Providers also need to implement the value agenda that starts with adopting the value goal and a culture of putting the patient first. Organizations that adopt a value agenda will reap benefits even if regulatory changes are slow. It requires learning to function as a team to remain viable. Call healthcare stakeholders to have a role to play in this strategy.

The value agenda

The strategy to move to a high-value health care delivery system entails organizing health care around the patient’s medical conditions, not the physician’s medical specialty. The challenge is to become a value-based organization, which starts from within. Physicians and provider organizations can put steps needed to improve value, while other stakeholders also have a role to play in the transformation.

Healthcare organizations should undertake large-scale changes involving multiple value agenda components. The result of this transformation is a striking improvement in outcomes and efficiency as well as growth in market share. Implementing the value agenda is an open-ended commitment that starts by adopting the goal of volume.

Most patients in the United States receive Medicare and Medicaid coverage that reimburses at a fraction of private plan levels. This means more independent hospitals should join health systems while physicians should move out of private practice and become salaried employees of hospitals. This is a necessary transition that allows providers to work under multiple payment models. The change will enable hospitals and physician groups to have positive margins still.

Bottom line

Employers need to familiarize themselves with the three healthcare reform components to avoid penalties and ensure employees have the required coverage under Healthcare reform. Insurance providers who cling to the broken system will be left behind in the health care reform. This is because it will become untenable to maintain the current cost structures and prices when the industry faces greater transparency and falling reimbursement levels.

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