Hospitals and health care systems are striving to achieve the Triple Aim—improving the patient experience, improving the health of populations and reducing the cost of health care. To achieve these goals, hospital leaders are designing new care delivery systems. Adoption of these new systems can be facilitated by new and innovative payment models that center on individual and community needs by rewarding high quality.
Two AHA committees, the 2015 Committee on Research and 2015 Committee on Performance Improvement, released a joint report, "Care and Payment Models to Achieve the Triple Aim," which addresses how hospitals can develop new delivery systems and innovative payment models that best meet the needs of their organizations and communities.
For its part, the 2015 Committee on Performance Improvement studied design and redesign of a new care delivery system and identified seven key principles:
- Design the care delivery system with the whole person at the center;
- Empower people and the care delivery system itself with information, technology and transparency to promote health;
- Build care management and coordination systems;
- Integrate behavioral health and social determinants of health with physical health;
- Develop collaborative leadership;
- Integrate care delivery into the community; and
- Create safe and highly reliable health care organizations.
In addition the 2015 Committee on Research discussed several new payment models that have emerged as the health care field transforms to a value-based care system, which derive from one of three fundamental payment approaches:
- Service-based payment, which is based on the fee-for-service mechanism
- Bundled-based payment, which aggregates different services and providers, such as hospitals, physicians and post-acute providers bundling cost for hip replacements
- Population-based payment, which seeks to aggregate total care and costs across the continuum, such as an accountable care organization for a defined population
Additionally, the Committee identified risk adjustments and incentives that drive care quality and efficiency should include:
- Patient safety and experience;
- Teaching status;
- Socioeconomic adjustment of the population served; and
- Support for transitioning to a new model.
As hospitals and health systems continue to evolve, they need to choose what model works for them and their communities so that the best care can be provided at the best value.