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This week’s guest post comes from Justin Chang, M.D., chief of emergency services, Kaiser Permanente, Colorado, and medical director, Exempla St. Joseph Hospital Emergency Department. A proponent of collaboration and enhanced coordination of care, Dr. Chang makes the case for a new model of healthcare delivery as defined March 31 by the Centers for Medicare & Medicaid Services (CMS) in its proposed ruling on Accountable Care Organizations (ACOs).
I think we can all agree — physician, payer, provider, patient, etc. — that the ultimate goal of regulations and reform should be to improve the delivery of healthcare, lowering costs and ultimately, making patients healthier and more satisfied. Coupled with driving toward the results defined by CMS, this requires some fairly significant changes in how healthcare providers operate — changes which may rightfully make some providers uneasy. But what many of us may not realize is that hospitals, physicians and payers across the country are already becoming advocates for the types of changes ACOs will require, supporting a shift away from the fee-for-service and silo-type models, even before the regulations go into effect.
Football season may be over for the year. But for payers, the idea that “as goes the quarterback so goes the team” has never resonated as loudly as it does now — and will in the future — in the new world of Sustainable Health Communities.
Historically, payers have had an important, yet somewhat fundamental role: to select and manage risk, to negotiate favorable provider contracts, ensure its network is comprehensive, design appropriate benefit plans, manage care and provide appropriate customer service. Now, as we enter the era of Sustainable Health Communities, payers take on a new and even more critical function as the enabler — the head coach of the team where the primary care physician (PCP) is the “quarterback” in the local health care delivery system.
This week, Dr. Shari Medina – Senior Director of Clinical Informatics at Picis, Inc. – discusses the evolving role of physicians within Sustainable Health Communities.
It’s no secret that healthcare’s inevitable move toward sustainable health communities (SHC) has many physicians feeling a bit…nervous. Admittedly, most physicians are creatures of habit who fiercely defend their individual approach to patient care, focus on cures not cost, and dread the concept of “cookbook medicine.” And under the SHC model, physicians are going to, without a doubt, be expected to move out of their comfort zones. But while SHCs will put new pressures on physicians to observe and adhere to evidence-based best practices, they will also allow physicians to preserve and deeply embrace the “art of medicine,” as well as enhance physicians’ skills and help improve outcomes by enabling them to spend more quality time with patients.
This week, Bill Miller – OptumInsight EVP responsible for provider strategy and solutions – explains why Sustainable Health Communities are both possible and probable in the years ahead as guest blogger for Healthcare-Exchange.
The buzzword du jour in healthcare is “Accountable Care Organizations”, or ACOs. The cynics among us might ask “Weren’t we calling these ‘medical homes’ just a few short months ago?” Those with long memories in addition to that dose of cynicism hark back twenty years and say these are just capitated HMOs.
The term is hardly what’s most important as the healthcare system evolves in response to healthcare reform, ARRA meaningful use, spending cuts, increasing regulation and a myriad of other influences, many of which are beyond the control of the hospital community. What matters is the outcome, the building and operation of what we at Ingenix refer to as Sustainable Health Communities.
