By now, most of us have heard that health care is moving from "volume to value."
What does that mean for us?
In our current paradigm, PeaceHealth provides a service (an office visit, lab test, imaging study, ED visit, hospital admission, etc.) and bills for it on a fee-for-service basis. We then get reimbursed regardless of the outcome of our efforts.
In the emerging pay-for-value world, increasingly we will be rewarded for clinical outcomes rather than for the number of services we provide. Indicators for quality, patient experience, and efficient use of resources will become paramount.
For PHMG, this means thinking about patients in a new way. We will no longer just focus on "the office visit." Rather, we will increasingly take on accountability for the total cost and quality of care for the population of patients who choose us as their care provider.
As a result, a new approach is required that includes the eventual addition of new team members to manage care beyond the traditional office visit.
We will work harder to keep our patients healthy, out of the ED and out of the hospital. It means we will have PHMG care managers working closely with the most complex cases and chronically ill, and social workers helping the most vulnerable. We will likely get more actively engaged in home care as well.
The investment for this new model is expensive and will need to be done gradually, in step with the changing way we get paid for our efforts, so we can support these new caregivers. Progress in developing our MyCare Team and a new focus by system leadership on payer strategy are both indicators of our commitment to embrace what is needed now.
With renewed focus on improving the health of the communities we serve, in many ways we are returning to the basic ideals of the Sisters who founded PeaceHealth. I believe we are poised for success.
