DIY Healthcare System: What is Health Reform and What’s its Special Connection to Quality, Safety and Accountability?

Posted on Wed, Dec 24, 2014
DIY Healthcare System: What is Health Reform and What’s its Special Connection to Quality, Safety and Accountability?


“You all are in the cat bird’s seat. Because you are in the hospital most of the time and in the ED particularly, the common pathway for entry into the hospital, you know what’s going on better than anyone else. You are in the best position to implement change. You are in the right spot at the right time. Our country needs your help.” With those words, David Nash, MD, MBA, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, opened EmCare’s 2014 annual conference with his presentation entitled, “Population Health & Quality in the New World of Health Reform.”

Dr. Nash, an accomplished educator and author, was instrumental in founding the country’s first school of population health. A board certified internist, Dr. Nash is passionate about the need to reform America’s healthcare system.

He divided his presentation into five parts:

  • How did we get into this jam?
  • What is quality in healthcare?
  • What’s population health, anyway?
  • What is health reform and what’s its special connection to quality, safety and accountability?
  • What’s in the future?

Over the next few weeks, we’ll post key takeaways from Dr. Nash’s presentation.

What is Health Reform and What’s its Special Connection to Quality, Safety and Accountability?

Dr. Nash asked attendees to consider these critical questions:
  • Are our efforts aimed at reforming healthcare or reforming health?
  • Can we align population health and health reform? How?
  • Have we reached the tipping point and are we ready to embrace reform?
  • Can we change the economic incentives to move from volume to value?
Health reform builds on five pillars – a national quality improvement strategy, quality measure development, value-based purchasing, prevention and wellness and new entities and authorities.

In order to achieve health reform, the country must address payment reform. There are four underlying concepts guiding these efforts:
  • Tying payment to evidence and outcomes rather than per unit of service (no outcome, no income)
  • Bundling payments for physician hospital service by episode or condition
  • Reimbursement for the coordination of care in a medical home
  • Accountability for results – a commitment to patient management across care settings.

Dr. Nash highlighted several payment models currently in existence or development including incremental fee for service payments for value, bundled payments and accountability for population health (risk-based payments). Nearly one-third of the nation is testing some form of bundled payment arrangement. He described the medical home concept as it relates to bundled payments for chronic care and disease carve-outs.

A medical home:
  • Relies on the team
  • Provides care for all
  • Measures performance
  • Encourages regular innovation
  • Includes mental health, PharmDs and more
  • Encompasses navigation and care
  • Requires management
  • Supports care through health information technology
  • Led by physicians

Accountable care organizations (ACOs) have emerged as the driving force behind population health. Dr. Nash predicted consolidation in ACOs and reminded attendees that a well-oiled primary care physician machine is necessary to keep the ACO running efficiently and effectively.

DIY: Healthcare System: What is Population Health, Anyway?

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