Study: Fragmented delivery system brings about poor U.S. health care system

A study released by the Commonwealth Fund Commission on a High Performance Health System identifies fragmented care at the national, state, community and practice levels as the primary cause of the poor performance of the U.S. health care system.

In “Organizing the U.S. Health Care Delivery System for High Performance,” the Fund identifies a few characteristics for the fractured system: lack of communication and coordination of care that leaves patients without guidance in different care settings and increases the chances of medical errors, waste and duplication of services from physicians; the absence of accountability, quality improvement programs and clinical information systems that leads to poor overall quality of care; and the lack of balance in compensation between high-cost procedures and primary care services that devalues preventive medicine and the management of chronic illness.

The Commission has identified six attributes to create the ideal health care delivery system:

• To provide physicians with their patients’ clinically relevant information at the point of care through electronic health record systems,
• To improve coordination of care among multiple providers by actively managing transitions across care settings,
• To promote accountability, review and collaboration within the health care team and with other teams,
• To increase patients’ access to care, including after business hours,
• To promote total care of patients, and
• To provide for continual innovation in the health care system to constantly improve quality, value and patient experience.

To achieve these attributes, health care advocates must take parts of existing delivery systems and reorganize them, the authors say, to achieve better quality and efficiency. This means implementing policy changes, and could require different modes of organization for different parts of the country.

Among the recommendations, the authors assert in the executive summary that the U.S. health care system must implement payment reform. This would involve moving away from the fee-for-service payment system toward bundled payment systems that reward coordinated care, and putting more pay-for-performance systems in place to reward quality. Primary care practices that provide medical homes would be offered alternate payment structures that include comprehensive prepayment for services or fee-for-service payments plus a per-patient care management fee. The authors also state that physicians should be trained for team care and should be required to implement and utilize certified electronic health records within the next five years.

To read the full report, go to the Commonwealth Fund Web site or click here for the PDF.