Delivery System Reform Issues

Medical home

Should everybody have a physician or a group of physicians that is responsible for managing their care?

Yes. In our fragmented system, people need a primary care access point to help them navigate the health system and coordinate their care. Currently, no person or organization is responsible for managing episodes of care, continuity of care, or patient outcome. Poor access to primary care and direct access to specialty care also contribute to high health-care costs.
Yes, but. The payment system must be adjusted so primary care organizations are paid more. That also will encourage the development of a bigger, stronger primary care system.
No. People want freedom to manage their own care and go where they want to go. Also, there is little evidence medical homes would improve outcomes or reduce costs.

Accountable care organizations

Should primary care doctors, specialists and hospitals be asked to team up into broad health-care organizations, which are then paid a flat fee to manage and take accountability for the entire spectrum of a patient's health needs - especially for the Medicare population?

Yes. Providers will better coordinate their efforts and will pay more attention to costs and quality of care if they have a financial incentive to do so. They will also be able to develop the organizational structures that are necessary to deliver true integrated care.
No. There's no evidence that accountable care organizations would either save money or improve care. Medical monopolies could be created, which means higher prices. And patients could get locked into organizations and end up without choices.

Episodes of care/bundled payment

Should we be paying doctors and hospitals a flat fee for all the services it takes to make a patient well through a particular illness or condition, rather than pay for each visit and procedure?

Yes. Paying for entire episodes will result in more integrated care. When organizations and individuals are paid per procedure, there are more procedures and less accountability.
No. That creates an incentive to under-provide care.
Maybe. Both approaches to payment could create perverse incentives.

Transparency

Should performance information about doctors, hospitals and other parts of our health care system be readily available to consumers?

Yes. It's hard to choose intelligently between hospitals and doctors without objective data.
No. The data aren't fair. You can't reduce a provider's performance to a few data points, and some see sicker patients than others.

Health Care Reform: Structural Reforms

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