Slotkin Jonathan R, Ross Olivia A, Newman Eric D, Comrey Janet L, Watson Victoria, Lee Rachel V, Brosious Megan M, Gerrity Gloria, Davis Scott M, Paul Jacquelyn, Miller E Lynn, Feinberg David T, Toms Steven A
Department of Neurosurgery, Neuro-sciences Institute, Geisinger Health System, Danville, Pennsylvania.
The Pacific Business Group on Health, San Francisco, California.
Neurosurgery. 2017 Apr 1;80(4S):S50-S58. doi: 10.1093/neuros/nyx004.
One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change.
在美国经常观察到的医疗保健脱节的一个重要驱动因素是传统的按服务收费支付模式，这种模式在经济上激励的是所提供护理的数量，而非护理质量和协调性。卫生服务购买者在面对基本相似的护理情况时，医疗费用存在广泛且往往不合理的差异，这使问题更加复杂。在过去十年中，许多利益相关者组织开始试验新型财务支付模式，力求消除传统基于数量的成本模式中固有的诸多挑战。《患者保护与平价医疗法案》使许多医疗服务提供系统能够与医疗保险合作开展基于诊疗事件的支付项目，如“改善护理捆绑支付”（BPCI）计划，以及基于患者的模式，如医疗保险共同节约计划。一些医疗服务的雇主购买者正在试验创新支付模式，包括基于诊疗事件的捆绑费率卓越医疗中心项目以及直接购买 accountable care organization（可问责医疗组织）服务。盖辛格医疗系统在基于诊疗事件的支付捆绑方面拥有超过十年的经验，同时进行了护理服务流程再造，这是其“ProvenCare®计划”不可或缺的一部分。盖辛格最近的经历包括参与 BPCI，以及通过太平洋商业健康集团（代表沃尔玛、劳氏公司和捷蓝航空）与医疗服务的雇主购买者建立合作关系。随着向以价值为导向的医疗服务提供和患者体验的转变不断推进，捆绑支付安排和医疗服务的直接购买将成为推动变革的关键财务驱动因素。
