Agency for Healthcare Research and Quality (AHRQ) established the Comparative Health System Performance Initiative. To address this gap in evidence, the U.S. ĭespite the adoption of integration as a primary reform strategy, there is presently a gap in evidence regarding which underlying structural changes in local health care delivery systems are most effective in achieving higher value care. Collectively, these emerging payment and delivery system models encourage coordination and integration across providers to ultimately improve quality and cost outcomes. įollowing the ACA, private and public sector payers have been shifting from fee-for-service reimbursement models to risk-based models that encourage shared accountability for the total costs of care between payers and providers. For example, growing financing and delivery system models, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs), are built on a foundation of primary care, shared accountability, and improved care management. The ACA established multiple programs and policies to test new delivery system and payment models that emphasize improved access to care and care management along the care continuum, furthering the incentives for integration among providers. policymaker attention to improving health outcomes and patient-centeredness as elements of health care value. This trend toward the vertical integration of various provider types has occurred while there has been a shift in U.S. Increasingly, hospitals, physicians, and other providers are consolidated into health systems. Major policy shifts, such as the Patient Protection and Affordable Care Act (ACA) of 2010, have in part fueled a resurgence in efforts to promote integrated care. health care delivery system experienced a shift in the predominant type of integration-from horizontal integration, when organizations acquire or integrate with other organizations that provide the same or similar services such as multihospital systems or multispecialty practice organizations -to vertical integration, when organizations acquire or integrate with organizations offering different levels of care, services, or functions such as hospital ownership of physician practices. Between the 1980s and mid-1990s, the U.S. Although the integration of providers has been a persistent strategy, the type of integration and its goals have varied over time.
federal and state policies, as well as local market factors, have influenced how, and which types of, providers work together to care for patient populations.
“Integrated care” has been defined as “a coherent set of methods and models on the funding, administrative, organizational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors”. policymakers and payers have viewed integrated care as a strategy for improving health care quality and efficiency. health care system has been found to incur higher costs but yield lower access, quality, and population health outcomes. At the same time, hospitals, physicians, and other providers, such as post-acute care providers, are structurally and contractually organized in diverse arrangements, with varying levels of autonomy.Ĭompared to many other industrialized countries, the U.S. These players develop eligibility policies, determine which services will be covered, contract with provider networks, establish provider reimbursement models, and engage in some level of care management. The result of this heterogeneous coverage environment is that multiple players, including federal and state policymakers and private payers, influence the health care delivery system and patient care. Individuals obtain health insurance through private or public sources that target certain patient populations on the basis of employment, age, disability status, income status, military service, or other factors, while a portion of society remains uninsured for various reasons. health care delivery system is characterized by complexity.
0 kommentar(er)
