Durovich Christopher J, Roberts Peter W
1 Office of the CEO, Children's Health System of Texas , Dallas, Texas.
2 Population Health and Insurance Services, Children's Health System of Texas , Dallas, Texas.
Popul Health Manag. 2018 Feb;21(1):13-19. doi: 10.1089/pop.2017.0015. Epub 2017 May 24.
The pace of change from volume-based to value-based payment in health care varies dramatically among markets. Regardless of the ultimate disposition of the Affordable Care Act, employers and public-private payers will continue to increase pressure on health care providers to assume financial risk for populations in the form of shared savings, bundled payments, downside risk, or even capitation. This article outlines a suggested road map and practical considerations for health systems that are building or planning to build population health capabilities to meet the needs of their local markets. The authors review the traditional core capabilities needed to address the medical determinants of health for a population. They also share an innovative approach to community service integration to address the social determinants of health and the engagement of families to improve their own health and well-being. The foundational approach is to connect insurance products, the health care delivery system, and community service agencies around the family's well-being goals using human-centered design strategy.
医疗保健领域从基于数量的支付向基于价值的支付转变的速度在不同市场之间存在巨大差异。无论《平价医疗法案》的最终走向如何，雇主以及公私支付方将继续加大对医疗保健提供者的压力，要求其以共享储蓄、捆绑支付、下行风险甚至按人头计费的形式，为人群承担财务风险。本文为正在构建或计划构建人群健康能力以满足当地市场需求的医疗系统概述了一份建议路线图和实际考量因素。作者回顾了应对人群健康医疗决定因素所需的传统核心能力。他们还分享了一种创新的社区服务整合方法，以应对健康的社会决定因素，并促使家庭参与以改善自身健康和福祉。基本方法是运用以人为本的设计策略，围绕家庭的福祉目标将保险产品、医疗保健服务提供系统和社区服务机构联系起来。
