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Value Based Health Care

Healthcare system is struggling globally with the rising costs and uneven quality of health care services in spite of the hard work of benevolent, well-trained clinicians. Policy makers in collaboration with health care leaders have implemented a considerable number of changes including reducing errors, enforcing guidelines and implementing electronic medical records, but more still needs to be done given the current state of health.

In the US, the healthcare system is facing unmatched force to change especially from a supply-driven system that emphasises on what physicians do instead of the needs of the patients (Wicks & Keevil, 2014). Additionally, the system focuses on the volume and profitability of the services offered at the expense of patient outcomes. Experts in the field of health have projected that considerable and complex pressures are set to transform the system that is currently evolving.

Societal shifts, policy changes, and technological advances, which continuously make the transformation inevitable, underpin the evolution of the system (Wicks & Keevil, 2014). To ensure a bright future for the US healthcare system it is time for fundamental changes whose core focus should be the maximisation of the value of patients. Technology is beneficial indeed, but it should be inclined towards benefiting the patient such that it should centre on the needs of patients in ensuring they get quality healthcare services at the lowest possible cost.

For that matter, an overhaul of the currently fragmented system to establish and develop a system in which services for different medical conditions are concentrated in health delivery organisations in order to ensure delivery of quality health care services is due. The future of the US healthcare system is promising if it continuously develops to be exclusively patient-centered, value based, defragmented and affordable to everyone while incorporating all healthcare stakeholders. Shaping the future health care system in the US

Development of value-based health care is well under way although while some organisations have already implemented fundamental changes, others are still at initial stages. As a result, it is no longer about the question of how to increase the value of care, but about the organisations that will lead the way. As of Wilensky (2014), real transformation can only come from within, and this starts with physicians and healthcare provider organisations. This emanates from the fact that value is highly likely to be determined by how medicine is practised.

However, every stakeholder in the healthcare system including patients, healthcare plans, employers, and suppliers are likely to be of significance especially in hastening the transformation. As indicated earlier, a value-based system is likely to require incorporation of physicians into the mainstream functioning of the patient-centered system. This is because they are the ultimate determinants of how medicine is practised, which is the foundation of healthcare that is organised around the needs of patients (Lee & Cosgrove, 2014).

This orientation means that it will be the end of physician-centered healthcare services, hence the end of status quo. This is likely to disorient the traditional position held by physicians because apart from them achieving reduced economy, a reduction in income for some of the physicians is likely to result as the health care system moves away from the fee-for-service model. Under the fee-for-service model, physicians are paid according to the times a patient make a visit, the hospitalisations the physician secures, and the number and cost of procedures and tests the physicians’ request.

Therefore, to ensure fast transformation, physicians’ role is instrumental and as the healthcare system remodels, the novel care should be capable of physicians embrace, without which it will not succeed. Healthcare insurance companies are also key stakeholders in achieving a value-based healthcare system. This emanates from the fact that Americans consider health insurance a necessity rather than a luxury (Navarro & Cahill, 2009). However, it is noteworthy that among all industrialised nations, the US is the only nation that does not make available universal health insurance coverage on a national level for all of its citizens.

Insurance is only available to the old above 65 years and the disabled through the Medicare program and the needy through the Medicaid program. The rest receive their insurance through group insurance, which mostly applies for the employed, while those who can afford self-insuring themselves. Evidently, in as much as the insurance arrangements were meant for cost savings, the local and national competitive markets, as well as healthcare policy issues, have continued to influence the evolution of healthcare as the services increasingly become market driven.

Ensuring that healthcare delivery, in the US, is value-driven reorganising how health is paid for will be instrumental, and thus making health insurance companies a worthy stakeholder in the transformation of healthcare in the US. Healthcare organisations are key stakeholders, and this emanates from the fact that embracing the goal of value has to start with the senior management because it requires that there is a fundamental departure from the past.

Even though health care organisations have not been against improving health outcomes, it is evident that they have always focused on growing and maintaining volumes rather than creating value for the services, they provide (Wilensky, 2014). This tendency to follow legacy delivery approaches, in addition to payment structures that have been in operation for decades has only served to reinforce the problem leading to low-quality health care services and untenable costs.

Therefore, the healthcare provider organisations’ involvement in the entire issue will be instrumental in hastening the transformation of the US healthcare system. Value for patients should be the goal for the future of US healthcare, which means that health outcomes that matter are achievable for the patient relative to the cost incurred in arriving at the outcomes. Patients are thus key stakeholders because they will be needed to take steps to ensure that they are not only concerned with their biological health, but overall well-being.

Ensuring that Americans get away from the belief that the health system is a “fix me system” through efforts to encourage them to make behavioural choices such as diet, exercise, tobacco and alcohol use that are most likely to keep them well is instrumental (Kovner, & Knickman, 2011). This is because, by the time some Americans go to the hospital, which is mostly when the medical condition is severe, it is expensive to treat such a person, and often too late in the process of medical science to ensure much good.

For that matter, how patients think about keeping healthy is likely to have a considerable effect on the on health outcomes, thus a key stakeholder in the transformation of the US healthcare system in ensuring delivery of quality healthcare services at affordable costs. The Affordable Care Act and journey towards universal Medicare The Affordable Care Act (ACA) has received considerable criticism for not being capable of meeting its goals. However, time is likely to determine the correctness or wrongness of the aforementioned statement.

However, it is clear that the ACA may face radical changes, which might make it claw back or represent a step towards a well sought after nationalised healthcare system that is free from fragmentation to ensure quality and affordable healthcare. However, this transformation is highly dependent on the political climate of the day. Already ACA has shown its strengths in ensuring that uninsured individuals get health insurance. According to Wilensky (2014), in the first quarter of 2014, the healthcare spending grew rapidly, which is an indication of how ACA has made it possible for people to access the healthcare system.

A further analysis by Krugman, a strong advocate for universal Medicare indicated that having people on Medicare rather than private insurance reduces healthcare spending, which is a goal ACA seeks to achieve, while it makes steps towards universal coverage However, it is evident that making access to healthcare a right rather than a privilege has consequences. This is because of the likelihood of opportunism that is likely to result in increased healthcare spending.

ACA roots for universal Medicare, which embraces the notion of care for all, but in a situation where business plays a significant role in shaping the behaviours of people, the applicability of ACA is yet to be tested. This is because for ACA to succeed it will require a balancing of trust among patients and at the same time checking on the instances of opportunism (Wicks & Keevil, 2014). This is because these biases are likely to show up in a clinical setting through the pay for performance and measurement of goals that are contained in ACA, which is likely to result in doctors over-diagnosing their patients.

This is because of the fact that in making diagnoses, the decisions of medical professionals are not only under the function of patient illnesses but also biases that influence behaviour subconsciously among the healthcare professionals (Wicks & Keevil, 2014). For example, the coding system a hospital uses is likely to influence clinical diagnoses made. Additionally, unconscious racial biases may also play a role, and this together with demands that ACA requires of healthcare professionals may result in a long list of diagnoses that can make the patient seem even sicker than he is thus affecting his future treatment.

Therefore, in spite of ACA increasing accessibility to the healthcare system, its design and language are likely to behaviours of patients, payers, and providers. Therefore, what happens to ACA is mainly dependent upon the direction the US healthcare system is likely to take in ensuring that universal Medicare does not compromise delivery of quality affordable care. Healthcare spending and political ideologies Political ideologies are thus, highly likely to play an instrumental role in the future because of their capability to shape the discourse of national spending.

It is certain that universal Medicare is likely to increase national spending, which will be detrimental to the wealthy few who are capable of self-insuring themselves. Therefore, as to whether the value-based system is to be successful or not will be underpinned by how well the advocates for universal Medicare position themselves in reconciling increased healthcare spending with quality healthcare. Quality healthcare is a function of a value-based healthcare system that is patient-centered, but without some regulations to keep in check

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