One of the most often-repeated concerns among healthcare providers relates to the volume and pace of change. While acknowledging that change is designed to improve care delivery, expectations are high. Healthcare providers are paving the road as they drive down it. The destination is foggy and the path winding.
Healthcare providers got into their line of work because of who they are, how they behave and how they think. They want to help people; they want to “do no harm.” But they are faced with some frightening statistics in several areas across the healthcare system:
- Overall quality of care, specifically concerning preventable harm and mortality, is concerning. More than 15 years ago, in 1999, the Institute of Medicine released the critical report “To Err Is Human: Building a Safer Health System.” In the report, the authors state, “Health care in the United States is not as safe as it should be — and can be. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented, according to estimates from two major studies. Even using the lower estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats as motor-vehicle wrecks, breast cancer and AIDS.”
- Unsustainable costs and waste are prevalent. The Robert Wood Johnson Foundation concluded in late 2012 that “the drivers of health care cost growth are complex and multifaceted and no single driver is responsible for the nation’s high and rising health care costs.” The authors explored the many factors that are driving current levels of spending on healthcare, including fee-for-service reimbursement; fragmentation in care delivery; an aging population; rising rates of chronic disease and comorbidities; advances in medical technology; lack of transparency about cost and quality, compounded by limited data; market consolidation and competition for providers and insurers; the legal and regulatory environment; and the overall supply of the health professional workforce.
- Despite high costs and utilization, U.S. healthcare performance lags behind other developed countries. According to the 2014 Commonwealth Fund report “Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally,” the United States health care system is the “most expensive in the world, and consistently underperforms relative to other countries on most dimensions of performance.” Among the 11 nations studied — Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States — the U.S. ranks last, or near last, on dimensions of access, efficiency and equity.
- Evolving models of care create new partners and new incentives. As payment models shift from fee-for-volume to fee-for-value, providers are creating partnerships and processes to deliver care across the continuum. Being responsible for the health of entire populations, versus managing a patient in an episodic manner, is a dramatic shift for providers. Doing No shortage of challenges 4 more no longer equates to being paid more. And this is not a fad; it is a fact. Witness the recent Department of Health and Human Services announcement predicting that 50 percent of all Medicare payments will be tied to value by 2018. And the announcement by one of the largest U.S. health systems, Trinity Health, stating they expect 75 percent of care to be delivered in bundles or through accountable care organizations by 2020.