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Review current types of health care delivery systems in the United States and contrast the current status with the reform models or revisions proposed in the readings for this topic. Select one area in health care delivery where change or reform to the current system could improve the delivery of allied health care and present your findings.
The U.S. healthcare system is a complex mix of public and private entities, traditionally defined by its fragmented nature and reliance on fee-for-service (FFS) payment. Contrasting this status quo with proposed reform models highlights a crucial shift toward value-based, coordinated care.
The current U.S. landscape primarily includes four major models:
Private Insurance/Fee-for-Service (FFS): This is the dominant model, where services are reimbursed individually. It incentivizes the volume of care (more tests, procedures) over the value or outcome of care. This leads to fragmentation, as different providers (physicians, specialists, hospitals) operate independently.
Managed Care Organizations (MCOs) / Health Maintenance Organizations (HMOs): These systems aim to control costs by managing utilization, typically requiring patients to use in-network providers. They represent an attempt to integrate care and focus on prevention, but often face criticism for restricting patient choice
Public Insurance (Medicare and Medicaid): These programs, primarily funded by the government, cover the elderly, disabled, and low-income populations. They are often the testing grounds for payment reform but operate under complex regulatory and reimbursement rules.
Integrated Delivery Systems (IDS): Organizations like Kaiser Permanente or the Veterans Health Administration (VA) own the facilities, employ the physicians, and manage the insurance plan. They are characterized by vertical integration and have a stronger natural incentive for coordination and efficiency than FFS systems.
| Current System Characteristic | Reform Model/Revision Proposed |
| Payment Model | Fee-for-Service (FFS) |
| Focus | Treating Sickness/Reactive Care |
| Care Structure | Fragmented, Specialist-Driven |
| Information Flow | Siloed, Paper-Based or Unlinked EHRs |
The central theme of modern healthcare reform is the transition from volume to value.
Accountable Care Organizations (ACOs): Groups of providers who agree to be held accountable for the overall cost and quality of care for a defined patient population. If they meet quality targets and spend less than a projected benchmark, they share the savings (Shared Savings Model). This directly counters the FFS incentive for high volume.
Patient-Centered Medical Homes (PCMHs): These models emphasize primary care as the central hub for coordinated, continuous, and comprehensive care, leveraging technology and interprofessional teams to manage patients holistically.
Bundled Payments: A single payment is made for an entire episode of care (e.g., knee replacement surgery), requiring all providers involved (surgeon, hospital, physical therapist) to collaborate efficiently to manage costs while maintaining quality. This forces coordination that is absent in the current FFS model.
I will select the area of Post-Acute Care Transition and Coordination as the focus for reform, specifically addressing the fragmented delivery of allied health services (e.g., physical therapy, occupational therapy, home health nursing).
In the current FFS system, patients transitioning from a hospital stay often receive fragmented allied health services. The hospital's discharge planner (a social worker or nurse) may refer the patient to an outside home health agency for nursing and a separate outpatient clinic for physical therapy.