Healthcare Delivery System
- Doctors and hospitals practicing in the same community and caring for the same patients are not "connected" to each other.
- The Affordable Care Act creates a new Center for Medicare and Medicaid Innovation that will research, develop, test, and expand innovative payment and delivery arrangements.
- The Affordable Care Act established guidance for the formation of Accountable Care Organizations (ACOs) that allow hospitals and doctors to work together to manage and coordinate care and provides that these ACOs will receive a share of the savings they achieve for Medicare.
Our health system is broken and much of the problem lies with the fragmentation of our delivery system which drives low-quality and inefficient care in a country filled with highly skilled health care professionals. The US lacks a single national entity or set of policies guiding the health care system; doctors and hospitals practicing in the same community and caring for the same patients are not "connected" to each other. Our current healthcare payment model—a mix of private insurers and public programs, each with its own set of rules and payment algorithms —further fragments the health care delivery system, contributing to waste and high administrative costs.
The Affordable Care Act provides opportunity for delivery system reform to ensure that patients are getting the right care at the right time in a coordinated, collaborative and efficient manner. The delivery system changes authorized in the new law are often in pilots or demonstration projects which can give us the opportunity to learn what works and what does not work for delivery system improvement. Some of the provisions for delivery system reform include:
- Mandates that the Secretary of Health and Human Services adopt value-based purchasing and payment methods for Medicare reimbursements for both physicians and hospitals.
- Creates incentives to reduce preventable hospital admissions.
- Creates a new Center for Medicare and Medicaid Innovation that will research, develop, test, and expand innovative payment and delivery arrangements.
- Encourages the formation of Accountable Care Organizations (ACOs) that allow hospitals and doctors to work together to manage and coordinate care and provides that these ACOs will receive a share of the savings they achieve for Medicare.
There are opportunities to increase the collaboration and coordination of care through new models such as the Patient Centered Medical Home (PCMH). The PCMH is model of care that is designed to improve quality and achieve efficiencies by recognizing and supporting the value of care that is provided to patients by primary care physicians, working in practices that have the information systems needed to achieve the best outcomes. The model is based on a large and growing body of evidence that shows that care delivered by primary care physicians, supported with information systems and with the appropriate reimbursement incentives, can improve the quality and efficiency of care provided to patients, especially for patients with multiple chronic illnesses.
Find Out More
- Affordable Care Act: Innovative Delivery Reforms
- Commonwealth Fund: Organizing the US Health Care System for High Performance
- Patient Centered Primary Care Collaborative
- Health Affairs and Robert Wood Johnson: Accountable Care Organizations
- Centers for Medicare and Medicaid Services: Accountable Care Organizations
- Urban Institute: Can Accountable Care Organizations Improve the Value of Health Care
- NEJM: Health Reform: Towards a Value-based System