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Organizing the U.S. Health Care Delivery System for High Performance |
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From The Commonwealth Fund: This report from The Commonwealth Fund Commission on a High Performance Health System examines fragmentation in our health care delivery system and offers policy recommendations to stimulate greater organization---established mechanisms for working across providers and care settings. Fragmentation fosters frustrating and dangerous patient experiences, especially for patients obtaining care from multiple providers in a variety of settings. It also leads to waste and duplication, hindering providers' ability to deliver high-quality, efficient care. Moreover, our fragmented system rewards high-cost, intensive medical intervention over higher-value primary care, including preventive medicine and the management of chronic illness. The solutions are complex and will require new financial incentives, changes to the regulatory, professional, and educational environments, and support for new infrastructure. Health care delivery in the United States has long been described as a "cottage industry," characterized by fragmentation at the national, state, community, and practice levels. Policy interventions are needed for this critical component of health system reform. The policies should move the system toward achievement of the attributes of the ideal delivery system we have identified. Provider payment reform offers the opportunity to stimulate greater organization as well as higher performance. We recommend that payers move away from fee-for-service toward bundled payment systems that reward coordinated, high-value care. Medicare should support further demonstration projects that test innovations in o payment design and care delivery. In such instances, we propose that the government play a greater role in facilitating or establishing the infrastructure for an organized delivery system, for example through assistance in establishing care coordination networks, care management services, after-hours coverage, health information technology, and performance improvement activities.
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