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

http://www.nxtbook.com/naylor/CMSQ/CMSQ1118
http://www.nxtbook.com/naylor/CMSQ/CMSQ0417
http://www.nxtbook.com/naylor/CMSQ/CMSQ1417
http://www.nxtbook.com/naylor/CMSQ/CMSQ0317
http://www.nxtbook.com/naylor/CMSQ/CMSQ1317
http://www.nxtbook.com/naylor/CMSQ/CMSQ0217
http://www.nxtbook.com/naylor/CMSQ/CMSQ1217
http://www.nxtbook.com/naylor/CMSQ/CMSQ0117
http://www.nxtbook.com/naylor/CMSQ/CMSQ1117
http://www.nxtbook.com/naylor/CMSQ/CMSQ0416
http://www.nxtbook.com/naylor/CMSQ/CMSQ1416
http://www.nxtbook.com/naylor/CMSQ/CMSQ0316
http://www.nxtbook.com/naylor/CMSQ/CMSQ1316
http://www.nxtbook.com/naylor/CMSQ/CMSQ0216
http://www.nxtbook.com/naylor/CMSQ/CMSQ1216
http://www.nxtbook.com/naylor/CMSQ/CMSQ0116
http://www.nxtbook.com/naylor/CMSQ/CMSQ1116
http://www.nxtbook.com/naylor/CMSQ/CMSQ0415
http://www.nxtbook.com/naylor/CMSQ/CMSQ1415
http://www.nxtbook.com/naylor/CMSQ/CMSQ0315
http://www.nxtbook.com/naylor/CMSQ/CMSQ1315
http://www.nxtbook.com/naylor/CMSQ/CMSQ0215
http://www.nxtbook.com/naylor/CMSQ/CMSQ1215
http://www.nxtbook.com/naylor/CMSQ/CMSQ0115
http://www.nxtbook.com/naylor/CMSQ/CMSQ1115
http://www.nxtbook.com/naylor/CMSQ/CMSQ0414
http://www.nxtbook.com/naylor/CMSQ/CMSQ1414
http://www.nxtbook.com/naylor/CMSQ/CMSQ0314
http://www.nxtbook.com/naylor/CMSQ/CMSQ1314
http://www.nxtbook.com/naylor/CMSQ/CMSQ0214
http://www.nxtbook.com/naylor/CMSQ/CMSQ1214
http://www.nxtbook.com/naylor/CMSQ/CMSQ0114
http://www.nxtbook.com/naylor/CMSQ/CMSQ1114
http://www.nxtbook.com/naylor/CMSQ/CMSQ0413
http://www.nxtbook.com/naylor/CMSQ/CMSQ1413
http://www.nxtbook.com/naylor/CMSQ/CMSQ0313
http://www.nxtbook.com/naylor/CMSQ/CMSQ1313
http://www.nxtbook.com/naylor/CMSQ/CMSQ0213
http://www.nxtbook.com/naylor/CMSQ/CMSQ1213
http://www.nxtbook.com/naylor/CMSQ/CMSQ0113
http://www.nxtbook.com/naylor/CMSQ/CMSQ1113
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0111
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1111
http://www.nxtbookMEDIA.com