Controlling care delivery is key
A major focus of the Senate's current health care reform bill, America's Healthy Future Act of 2009, is providing health care coverage to more people -- and the bill does a fine job of outlining steps to accomplish that goal. However, the bill fails to pay enough attention to controlling utilization and the payment of services -- both factors that can impact health care costs.
A shortcoming in our current health care system is that medical providers are incented to give patients as much treatment as possible in the form of procedures, diagnostic tests, etc. Clinicians are still compensated per procedure or visit. Instead, we need to shift our focus to physicians meeting quality-care delivery targets and having incentives in place not just for more procedures, but for having healthy patients. The health care reform bill needs to identify and establish the specific mechanisms to ensure the appropriate delivery of quality care.
One way to deliver quality care, and by so doing control utilization and payment, is to encourage the development and use of accountable care organizations (ACOs) -- medical groups, physician organizations or health systems that work cooperatively to provide comprehensive clinical services for patients. These ACOs emphasize delivering quality care at a reasonable cost. Although there are many examples of effective ACOs in the country, the government is currently only exploring ACOs as demonstration projects. More needs to be done.
To constrain successfully long-term spending growth a health care reform bill needs to clearly establish the means of providing quality care that is both cost efficient and effective, and dis-incenting the continued growth in utilization of services.
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