Helen Hayes Hospital, West Haverstraw, Rockland County, NY 10993, USA.
J Cardiopulm Rehabil Prev. 2013 May-Jun;33(3):144-52. doi: 10.1097/HCR.0b013e31828f5602.
Because health care costs in the United States have been growing disproportionately compared to inflation for many years, without a clear connection to improved quality or increased access to care, employers and payers have begun to test new models of health care delivery and payment. These models are linked to the concepts of affordability, accountability, and accessibility and incorporate the premise that there must be shared responsibility for improving meaningful patient outcomes, with attention to the coordination of team-based and patient-centered care, and value for services purchased. This article explores emerging health care delivery and payment models, including expanded access to care related to the Affordable Care Act of 2010, patient-centered medical homes and neighborhoods, accountable and coordinated care organizations, and value-based purchasing and insurance design, with an emphasis on implications for cardiovascular and pulmonary rehabilitation programs and the American Association of Cardiovascular and Pulmonary Rehabilitation.
由于美国的医疗保健费用多年来一直不成比例地高于通胀，且与提高质量或增加获得医疗服务的机会没有明确联系，雇主和付款人已经开始测试新的医疗服务提供和支付模式。这些模式与可负担性、问责制和可及性的概念相关联，并包含了必须共同承担提高有意义的患者治疗结果的责任的前提，同时关注团队合作和以患者为中心的护理的协调以及所购买服务的价值。本文探讨了新兴的医疗服务提供和支付模式，包括与 2010 年《平价医疗法案》相关的扩大医疗服务获取机会、以患者为中心的医疗之家和社区、负责和协调的护理组织以及基于价值的购买和保险设计，并重点介绍了对心血管和肺康复计划以及美国心血管和肺康复协会的影响。
