CMSA Today - Issue 4, 2014 - (Page 14)

A Shift from Volume to Value Value-Driven Health Care The Role of Case Management Professionals BY GENE GOSSELIN, RN, MA, CCM, LPC T here is widespread agreement that the United States health care system is fragmented and volume-driven, and is disproportionately focused on caring for the acutely ill rather than on keeping people healthy. Often, patients receive treatments and medicines from multiple providers and are transitioned across settings or levels of care, with little communication occurring between these providers. Additionally, the fee-for-service reimbursement structure predominant today provides compensation for each unit of service. This reimbursement structure fails to align payment with quality and efficiency. As providers are paid separately for each service delivered, there is little incentive to coordinate care or collaborate with other providers, which can result in unnecessary or duplicative tests, medication errors and preventable hospital admissions and readmissions. Increasingly, the U.S. health care system is shifting from one that is volume-driven to one that is value-driven. The Patient Protection and Affordable Care Act (ACA) contains numerous mechanisms designed to move the U.S. health care system toward value-based care. Broadly, the ACA seeks to align incentives to enhance the achievement of better health outcomes, higher quality and greater efficiency. It also includes provisions that encourage patient-centered care and the exploration of different care coordination models. What is evolving is a system where providers stand to share in the savings that result from better disease management and improved care coordination. ADDING VALUE THROUGH CARE COORDINATION VALUE VOLUME 14 CMSA TODAY Issue 4 * 2014 Case management professionals are poised to play an increasingly important and vital role as hospitals, ambulatory care practices and other health care organizations seek to adopt new delivery models that align with new payment structures and encourage value-based health care. A focus on patient-centered, coordinated care is essential in these new models, and providers and hospitals that develop effective care coordination programs will be rewarded. These programs give service providers - including physicians, nurses, pharmacists, case managers, behavioral health specialists and others - the opportunity to work together and create unique teams designed to facilitate patient interactions with the health care system, while improving health outcomes and potentially reducing costs. The Agency for Healthcare Research and Quality (AHRQ) broadly defines care

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2014

President’s Letter
President-Elect’s Letter
Cmsa Corporate Partners
Association News
Value-Driven Health Care
The Dmaic Six Sigma Approach
Motivational Interviewing
Q & A
Medication Non-Adherence
Index of Advertisers

CMSA Today - Issue 4, 2014