Frontiers of Health Services Management - Summer 2014 - (Page 48)

the United States is an outlier among organisation for economic co-operation and Development (oecD) countries in how it balances medical and social expenditures. Most oecD nations, including the United States, spend roughly a third of their gross domestic product on a combination of social and health services. However, whereas for most nations the ratio is typically 2:1 in favor of social expenditure, the US social-to-health services ratio is less than 1:1 (Bradley et al. 2011). this ratio is problematic because "social" expenditures are For providers that do not powerful influences that operate their own health appear to positively affect plan, ACO development national health outcomes. if the United States were is one method by which to reduce wasteful, ineffito experiment with new cient, and ineffective treatments-an estimated 30 payment models. percent of current spending (nrc 2010)-some of those dollars could be redirected to support other types of programs and reduce the illness burden in the nation. Kindig and isham suggest that clinical delivery systems will need to step outside of their traditional business model and view the health status impacts through a broader lens. this is an important concept, whether we talk about broad-based community health business plans or "population health" interventions created by delivery systems to manage subpopulations. Historically, healthcare organizations have had little incentive to focus beyond individual medical services on the more broad health status of the population. as the United States continues to move away from a fee-for-service (ffS) payment method to models such as capitation, clinical delivery systems will redesign services to include a greater emphasis on those factors that affect health status other than traditional medical care. this responsibility for clinical and cost outcomes will align healthcare delivery system incentives more closely with community incentives for a healthy workforce and a healthy community. this realignment in turn may help us avoid the healthcare version of what economists refer to as the "tragedy of the commons," whereby a shared resource is sacrificed for the individual interests of a broad range of stakeholders, leading to everyone's long-term disadvantage (fadul 2009). ACOs as a Vehicle for Change the affordable care act (aca) provides new momentum for change. in addition to encouraging the growth of accountable care organizations (acos) and other payment pilots to better align clinical delivery and financing models, the federal Health insurance Marketplace and state-based exchanges facilitate increased access to subsidized health insurance coverage. as the Marketplace evolves and insurance and provider competition increase, there will be additional momentum for change. Payers are creating smaller networks of select providers offering volume steerage to the provider in exchange for lower rates or better cost management. "narrow networks," which exclude a percentage of healthcare providers in a given region, represent 70 percent of the insurance plans offered through the Health insurance Marketplace for the January 2014 enrollment period (McKinsey center 2013). currently, most healthcare organizations are intensely examining how to position themselves and navigate the volume-to-value journey as regulations change. of particular note is the shift in Medicare payments. in 2013, the second 48 * f ro ntier s o f h ea lt h s e rvic e s m a na g e me nt 30 :4

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2014

Table of Contents

Frontiers of Health Services Management - Summer 2014