The delivery of U.S. healthcare services is going through a profound change. Yet this change is occurring in the background and not apparent to the general public. The driving force behind this change is payment reform to healthcare providers for medical services delivered. The underpinning of this change is the reduction of cost in the delivery of healthcare services to make it more affordable. The initial step of payment reform has been the reimbursement models of Bundled Payments and Accountable Care Organizations. These new forms of reimbursement are forcing healthcare providers (hospitals, physicians and other care delivery services) to re-examine and redefine the delivery of services and working relationships. The changes being initiated are positive and took something extreme like payment reform to push organizations to look at how healthcare is delivered and make changes in the manner business is done. The outgrowth of these changes will be positive for our society by producing a higher quality of healthcare at a cost effective price.
With the transition to a more cost effective delivery of healthcare, we need to be mindful of continual cost pressures on these organizations. There is a fine line between cost effective healthcare and cost controlled healthcare where quality and choice can be sacrificed. As the delivery of healthcare models are evolving, one approach discussed is a regional managed care system. This is where a healthcare provider takes the ownership and risks associated with managing the healthcare of a defined geographic population. This approach is contrary to the free market competitive forces model. This could become a redefinition of the HMO which drove what medical services can be provided on a case-by-case basis. There is also the underlying premise that a regional managed care system can be excellent in the delivery of all medical disciplines. Given the complexity of medicine today, one organization cannot excel in the delivery of all medical disciplines. This is proven by various organizations nationally that have built their reputation as being the best in class for certain medical conditions.
The other risk with a regional managed care system is the potential limitation of selection for medical services from a provider outside of the system. Therefore, people within that defined geographic area may have a restricted choice in the care provider they would like to use for medical services. An analogy would be public school districting. If you live within an area, you can only attend one specific public school. If you want to attend another school in a different area, they may not accept you or charge a premium to enroll. Therefore, the forces around business competition and the need to excel and attract customers are diminished. The business environment is more of an artificial monopoly where alternative options are available at a higher personal price tag. Therefore your choice of healthcare provider is limited where your condition may be better treated in another town or state where the specialist is better qualified and demonstrating a higher quality of clinical outcomes.
As a community and a society, we want to support and engage in the process of redefining the delivery of healthcare where cost is reduced without sacrificing quality. We must be careful not to be lulled into complacency with progress where quality and breadth of services are sacrificed for the sake of cost reduction.