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HCA 610 Discussion Implications of Health Care Reform

HCA 610 Discussion Implications of Health Care Reform

Discuss at least two implications of health care reform on the health care organization’s goals and strategic plan. How will processes and operations need to be adjusted to meet the requirements of health care reform legislation?

Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that

HCA 610 Discussion Implications of Health Care Reform

health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined.

If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. The role of patients within clinician-patient relationships would be elevated, strengthening therapeutic relationships. Reframing health in terms of health-related goals and directing the health care system to help people achieve them, could both improve quality and reduce costs. In the process, it could also make health care less mechanical and more humane.

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We are about three decades into a concerted effort on the part of government and industry to reform our health care system, primarily because it is so expensive, but also because we have fallen behind other developed countries on most measures of population health. Recent improvement strategies have recognized the importance of primary care and have embraced the “Care Model,” developed by Ed Wagner and colleagues [1], and “Patient-Centered Medical Home” principles developed and adopted by the three major primary care professional associations [2]. These strategies require tighter adherence to evidence-based clinical practice guidelines, implementation of information technologies like electronic records, registries, and information exchange systems, and more effective teamwork.

Reformers are measuring the success of their efforts using the “Triple Aims,” a framework proposed by Donald Berwick, President Emeritus and Senior Fellow at the Institute for Healthcare Improvement and former Director of the Centers for Medicare and Medicaid Services. The Triple Aims are: (1) improving the quality of the care provided, (2) improving patient outcomes, and (3) reducing the cost of care [3]. Some have added a fourth Aim, improving the work life of health care providers.

Since the establishment of the Centers for Medicare and Medicaid Innovations center, a number of local and regional experiments are underway. Most include payment reforms designed to enhance primary care (e.g.: paying for care coordination and registries) and incentives to encourage clinicians to deliver evidence-based care. Many private experiments are also being conducted by health systems, insurance companies, and new health care businesses, including “Value-Based Purchasing” and “Direct Primary Care.”

Nearly all of these experiments emphasize improving care processes and reducing costs. The outcomes being measured are typically intermediate outcomes like hemoglobin A1c and blood pressure, rates of utilization of emergency and hospital services, and patient satisfaction, outcomes that can be obtained over short periods of time from readily available data. Clinicians have raised concerns about these metrics, but the financial concerns are so prescient that there appears to be little appetite for debate or for truly disruptive ideas.

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