Sangvai Devdutta G
executive director, Duke Connected Care; associate chief medical officer, Duke University Health System; medical director, DukeWELL; associate professor, Departments of Family Medicine, Pediatrics, and Psychiatry, School of Medicine, Duke University, Durham, North Carolina
N C Med J. 2016 Jul-Aug;77(4):254-6. doi: 10.18043/ncm.77.4.254.
Health care in the United States, and by extension in North Carolina, is in a perpetual state of flux. From the Nixon-era predictions of runaway costs to the insurance-anchored efforts of Hillarycare to wide-sweeping reforms of Obamacare, established providers are regularly counseling the next generation on how different medicine will look when they are in practice. The accuracy of some of these predictions aside, one thing is sure: the pace and magnitude of change is palpably different this time. Pushed by both private and public payers to move from fee-for-service to value-based care while striving to meet the Triple Aim of improving patient experience, improving population health, and reducing costs, all arenas of medicine--hospital-based, ambulatory, and public health--are feeling the pressure. At the same time, patients are acting more like consumers, demanding transparency in pricing and increased quality. In this issue of the NCMJ, experts from a broad range of backgrounds and health care organizations discuss the trials and rewards facing providers and health systems as they promise better outcomes and assume greater financial risk in care delivery. The ways that we are striving to meet new payment models--and the successes we are achieving--are as varied as the practices across North Carolina. In the following pages, you will read about the many efforts to implement these new models, both stories of success and a few cautionary tales.
美国的医疗保健，以及由此延伸至北卡罗来纳州的医疗保健，都处于一种持续变化的状态。从尼克松时代对成本失控的预测，到希拉里医保以保险为核心的努力，再到奥巴马医改的全面改革，老牌医疗服务提供者们经常向新一代传授他们从业时医疗行业将会有怎样的不同。暂且不论这些预测中的一些准确性如何，有一点是肯定的：这次变革的速度和幅度明显不同。在私人和公共支付方的推动下，医疗行业正从按服务收费转向基于价值的医疗，同时努力实现改善患者体验、提升人群健康水平和降低成本这三大目标，医疗行业的各个领域——医院、门诊和公共卫生——都感受到了压力。与此同时，患者的行为越来越像消费者，要求价格透明并提高医疗质量。在本期《北卡罗来纳医学杂志》中，来自广泛背景和医疗保健组织的专家们讨论了医疗服务提供者和医疗系统在承诺实现更好的治疗效果并在医疗服务中承担更大财务风险时所面临的考验和回报。我们努力适应新支付模式的方式——以及我们取得的成功——就像北卡罗来纳州各地的医疗实践一样多种多样。在接下来的几页中，你将读到许多实施这些新模式的努力，既有成功的故事，也有一些警示故事。
