Cost, Quality, And The Search For Value

By 2001 it was brutally apparent that the U.S. Health Care system was in dire need of a reform in regards to quality and patient safety. Following two separate reports issued by The Institute of Medicine (IOM), To Err is Human (1999) and Crossing the Quality Chasm: A New Health Care System for the 21st Century(2001) the U.S. Congress requested the IOM review quality processes across multiple government funded health care programs. And understandably, “these reports described America’s healthcare system as a tangled, highly fragmented web that often wastes resources by duplicating efforts, leaving unaccountable gaps in coverage, and failing to build on the strengths of all health professionals” (Brown J., p. I – 15, 2013). Thus, the Committee on the Quality of Health Care in America released 6 aims to address key dimensions that require improvement in our health care system. These aims propose that our system needs to strive to be more Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable (STEEEP). All of which were created to help overhaul our current health care system and, more importantly, narrow the quality chasm.

A powerful force for change can be created by embracing transparency. According to the Department of Health and Human Services, “transparency is a broad-scale initiative enabling consumers to compare quality and the price of health care services so they can make their own informative choices among doctors and hospitals. This initiative is laying the foundation for pooling and analyzing information about procedures, hospitals and physicians services. In order to create value driven health care, there are four steps to turn raw data into

The cost and quality of health care and access to it is one of the foremost aspirations in national health care. And the overall main aims of reforming the American health care system is to reduce costs, enhance the quality of and access to health care [1].

Though the spending has lessened in recent years ,when compared with other economically developed countries the cost of the health care in U.S is much higher and ranks poorly on quality indicators (Burke & Ryan, 2014).Evidence suggest that patient quality outcomes not generally correlated with variation spending .Beneficiaries are expected and deserved for high quality care within affordable

Cost has different perspectives depending on whom we are speaking about. Consumers refer to cost in reference to the price of healthcare, bills to insurance or payments to doctors directly. Nationally we refer to healthcare spending as a reflection of all healthcare spending that occurs in the nation and is normally measured in a percentage of the Gross domestic product or GDP. Provider costs are seen as the cost to pay staff, buying medical equipment and capital costs for buildings and the maintenance of the buildings infrastructure (Shi & Singh, 2005).

While the United States has some of the best doctors and healthcare facilities in the world we fail at being efficient and effective. Currently there are too many unplanned readmissions, medication errors and hospital acquired infections. The United States health system does not effectively provide preventive medicine for individuals with chronic diseases, and this portion of health care consumers account for the majority of health care costs (Kocher et al., 2010).

The fragmented and misaligned state of the U.S. health care system has become a catalyst for payment and delivery system reforms. Traditional fee-for service (FFS) payment structures incentivize high volume rather than high quality care, and lead to the suboptimal provision of medical services across the disjointed provider landscape. Despite various attempts to improve care delivery, health care costs continue to rise. The Accountable Care Organization (ACO) model seeks to reverse these trends by promoting a simultaneous restructure of the payment and delivery systems to incentivize higher quality, lower cost care.

In recent years, emphasis has been placed on improving the quality of health care services and the overall patient experience. Innovative measures are needed to meet these expectations, while also containing the rising costs of health care. The government has enacted new laws in attempts to provide incentives that base Medicare payments in part on quality. In fact, the Patient Protection and Affordable Care Act of 2010, requires the implementation of value-based purchasing (VBP), which bases Medicare reimbursement rates on the quality of care (Kennedy, Wetzel & Wright, 2013). Hospitals may experience a decrease in revenue initially, however, it is theorized that the increase of transparency and accountability will serve as an incentive for improvements in the overall quality of care provided in the United States.

United States has no dearth of highly qualified, well-trained doctors and still the US healthcare quality fails to meet the established industry benchmarks. Institute of Medicine’s (IOM’s) 2001 Report, “Crossing the Quality Chasm”, clearly states that the American healthcare delivery system is in need of a pivotal change. (Committee on Quality of Healthcare in America (Institute of Medicine), 2001). The exasperation level is continuously rising amongst both, the patients and the providers, and yet the problem of delivering and receiving high quality care remains unaffected. In order to address this problem of healthcare quality improvement and affordability, the Patient Protection and Affordable Care Act (PPACA or Obamacare) was signed in the year 2010. The main aim behind PPACA is to improve healthcare quality and accessibility, at the same time keeping it cost efficient. To facilitate its goal PPACA is trying to achieve the cost effectiveness through reducing the Medicare price growth and regulating the quantity of care by encouraging evidence based practices. This new legislation supports the healthcare system in which the goals of both provider and the patients are better aligned with value as opposed to the quantity of services. Overall the reform under PPACA seeks to establish a direct link between the payments made to the healthcare

Health care in the United States in known to be very pricey, with the quality of care not always meeting its expectations. In the year 2011 alone, the money spent towards healthcare was well over two trillion U.S. dollars. One answer to solve this dilemma would be to incorporate a value based care system. A value based care system is structured around the traditional evidence-based practice and medicine model, while emphasizing the quality of care, taking into consideration patient’s wishes and preferences at a reasonable cost in order to improve the quality of life (Harvard Business Review, 2013).

The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.

With incredibly high costs and a lack of high quality care, the multitier healthcare system of the United States has several major flaws. The system we have established has proven to no longer be practical in most, if not all major areas. Improvement initiatives (i.e. Oregon Health Plan, Leapfrog, Lean Manufacturing, and Pay-for-Performance) have been implemented into the current system, and all of them are under experimental measures to determine if they can bring pressure off of the healthcare system. With the increasing support for universal health coverage in order to decrease health disparities in the country, the current quality initiatives seem to be the best ways to improve the quality of care, reduce costs, and increase equality in healthcare. The purpose of this paper is to scope this social problem over the last 30-50 years and carefully examine and predict future problems that may arise if the system is not corrected promptly (Pushman & Chung, 2009).

To do this requires disruptive and transformational changes in how we pay for medical care, how we fund preventive medicine and public health, how we manage medical information, how we incentivize and pay healthcare providers, how we incentivize ourselves to take better care of our health, and how we assure that everyone has both access to care and the means to pay for it. This book is designed to inform the average healthcare consumer as well as the healthcare policymaker about what works and what does not in our current medical care delivery system, how it is changing, and how each individual's own actions can influence their health, the quality of their care, their healthcare costs, and their satisfaction with the healthcare they

The face of medicine is changing. We see new advancement in medicine and technologies on the horizon every day. Congress and the President have actively been discussing health care coverage for all Americans. The way we practice medicine today is far different from that of even 20 years ago. The delivery of medicine has in the past evolved along a fee-for-service model. Today there is a significant change from fee-for-service to payment based on quality received. This has been dubbed value-based purchasing. As this new remodel emerges finances will no longer be dominated by a system of volumes and productivity but will change to a system of preventative medicine and payment for quality of care. Those practices and providers who are leading

Thank you for your very inspiring post. You noted that “the call for evidence-based quality improvement and healthcare transformation underscores the need for redesigning care that is effective, safe, and efficient”. Most innovations stem from a need to improve certain services or products . Although these improvements are often of a limited nature, some are very significant. For example, the recent emergence of “retail clinics” constitutes the need to address the shortage in primary care providers in the nation. Consumers who are looking for convenient and immediate access to the healthcare system for the treatment of these common health problems drive the demand for these clinics. The shortage of primary care physicians and the resultant long waits for appointments have added to an environment that is primed for this innovative health care services. The retail clinic appeals to consumers due to accessibility, affordability and convenience. In addition, it appeals to current non-consumers, such as the uninsured, willing to pay an affordable fee for the opportunity to address their common healthcare needs.