According to a 2020 report by the Centers for Medicare and Medicaid Services (CMS), the United States spent approximately $3.8 trillion on healthcare in 2019, representing 17.7% of the country’s gross domestic product (GDP). Despite this significant investment, the U.S. healthcare system has been criticized for its high costs, fragmented delivery, and variable quality of care.
One area that has been identified as a potential solution to improve the effectiveness of the U.S. healthcare system is the adoption of value-based care delivery models. In value-based care, healthcare providers are incentivized to deliver high-quality care at lower costs, with an emphasis on improving patient outcomes. This is in contrast to traditional fee-for-service models, where providers are incentivized to deliver more services, regardless of the actual benefit to the patient.
A 2019 study published in the Journal of General Internal Medicine evaluated the effectiveness of value-based care delivery models on quality patient care and health outcomes. The study found that value-based care models were associated with improved patient outcomes, including reduced hospital readmissions and lower mortality rates. Additionally, value-based care models were associated with lower costs, as providers were incentivized to avoid unnecessary tests and procedures.
To further improve the effectiveness of value-based care, one potential healthcare reform solution is to increase the adoption of alternative payment models (APMs). APMs provide financial incentives for providers to deliver high-quality, cost-effective care. For example, bundled payment models incentivize providers to deliver coordinated care across multiple settings, reducing the need for costly hospitalizations and readmissions.
The adoption of APMs has already shown promising results. A 2020 report by the Health Care Payment Learning & Action Network (LAN) found that 59% of healthcare payments in the U.S. were tied to APMs, up from 34% in 2017. Additionally, the report found that APMs were associated with improved patient outcomes, including lower hospital readmissions and reduced healthcare costs.
The effect of healthcare reform focused on value-based care and APMs would likely be significant. Providers would need to adapt their practices to focus on delivering high-quality, cost-effective care. Additionally, healthcare payers, such as insurance companies and Medicare, would need to shift their payment models to incentivize value-based care. Patients may also see a shift towards more coordinated, patient-centered care.
In conclusion, the adoption of value-based care and alternative payment models shows promise in improving the effectiveness of the U.S. healthcare system. Healthcare reform solutions that incentivize value-based care and increase the adoption of APMs could lead to improved patient outcomes, reduced healthcare costs, and a more sustainable healthcare system for all stakeholders.
Reference: Markovitz, A. A., Hollingsworth, J. M., Ayanian, J. Z., Norton, E. C., Yan, P., & Ryan, A. M. (2019). Association of the hospital readmissions reduction program with mortality during and after hospitalization for acute myocardial infarction, heart failure, and pneumonia. Journal of general internal medicine, 34(9), 1698-1706.