The health reform legislation passed by Congress on Sunday—largely health insurance reform—is a big first step in addressing the need for universal healthcare coverage. Further hard work and reform will be required to handle the unintended consequences sure to arise from this legislation, as well as to enact positive changes regarding the actual delivery of and payment for healthcare services.
Even if actual care delivery is not addressed directly by any major federal legislative process, healthcare will be fundamentally redesigned in the near future. Why? First, the current cost trajectory is unsustainable, with piece rate payment incentives, a fragmented provider and insurance market, and no widespread application of best practice or evidence-based care. Second, we simply cannot continue with a system that provides care that ensures no benefit to patients.
It has long been an unfortunate part of our country's health financing system that providers are paid to provide more services, not more value. Changing this behavior is the fundamental cost reform needed to fund universal coverage. The key to truly changing the healthcare system in a positive way is to end unjustified variations and fragmentation of care giving, reimbursement mainly for units of work—not for acceptable outcomes, and patients as passive recipients of care. Instead, we must make positive changes to ensure affordable coverage for all, enact payment for value in healthcare delivery rather than for quantity, commit to best-practice, coordinated care, and include a mechanism to enable providers to continuously improve and rapidly develop innovative solutions. What's more, patients must take responsibility for being active partners in their good health.
Academic investigators are beginning to confirm that truly integrated delivery systems—those offering both care delivery and health insurance—are well positioned to provide excellent quality and value for individual patients as well as larger patient populations. Geisinger is fortunate to have a long history as an integrated health services organization. The bulk of healthcare providers across the United States, though, are made up of small physician practices and small community hospitals. The re-design of healthcare must initiate and grow accountable systems of care that accept responsibility and financial risk for delivering healthcare value to a population of patients. These may be integrated models like Geisinger or Kaiser in California, or they may be looser affiliations of independent providers in a community.
Clinical leaders must lead the process for redesign to be successful. Primary care physicians at the front door of the integrated system will need to work seamlessly with hospital-based specialists to provide value over time to patients with both acute and chronic care needs. Physicians and hospitals will need to work together within a common operational structure. And insurance companies will need to work with providers—both physicians and hospitals—not simply to negotiate acceptable "piece-rate" reimbursement, but to focus on how best to achieve optimal outcomes for the people we serve.
It is common knowledge that the country's current approach to healthcare is not sustainable, and something had to happen. While the new legislation is long, complicated and needs to be better understood by all, there is no denying the significance of this first step toward true healthcare reform. Geisinger continues to urge our elected officials in Washington DC to work toward providing a context within which all healthcare providers and payers will see their primary mission as the provision of efficient, high-quality care to all Americans.
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