The healthcare industry in the US is constantly changing. No doubt about that. It is a paradigm shift from a typical “I provide service and get paid” to “I improve population health and then get paid.” The idea behind this change is simple. Payers have been rolling out huge chunks of money only to see the quality of healthcare not improving in the same proportion as the cost. So to improve the quality of care, the elegant change was brought to life. This is what I think.
This elegant change has led to open questions from all around the industry as a whole. How does one track the health of a population? As a healthcare provider, what if I am situated in a disaster-hit area and the population I am treating is not as same in healthy terms as other parts of the country - I would end up losing money in the new model. Questions like these have been popping up and are still in the healthcare domain. To answer these questions, CMS is doing a wonderful job in taking questions from the industry and answering them. This just goes to show how healthcare industry right now is in transition.
Accountable care organizations(ACO) have taken over the mantle to reduce operating cost and provide a value-based care to improve the quality of care. For them, it is important to figure out the major cost heads, the right set of practices, payer contracts adherence among many different questions. They are in charge of keeping an eye on the quality measures and guidelines set forth by the government. If the measures fall in the lines specified by the government, the ACO’s receive incentives. All in all, improved quality of care and improved utilization equals dollars.