ProvenCare PDF: How to Deliver Value-Based Healthcare the Geisinger Way
|Author||Glenn D. Steele Jr. and David T. Feinberg|
|File size||5.28 MB|
The fundamental challenges in healthcare have not changed significantly in the nearly five decades of our involvement in health system leadership. Access, quality, and cost have always represented the underlying combination of intersecting and sometimes conflicting goals. During President Lyndon B. Johnson’s Great Society and the inception of the public payer with the introduction of Medicare and Medicaid in the 1960s, the focus was solely on ensuring adequate access for the elderly and poor citizens who could not then afford available insurance either on their own or through their employers.
Interestingly, the opening lines of the Medicare law asserted that the new entitlement would not in any way influence how medicine should be practiced. Through the “Hillary care” debates in the 1990s and into the new millennium, it became obvious to the entire nation and even more so at the individual state budget level that increased access to care without formal expectation of better outcome would drive societal cost to unsustainable and uncompetitive levels. Amazingly, state and federal regulations continued to demand unfettered fee- for- service reimbursement, as it was felt to be critical to maintain the sacrosanct relationship between patients and providers. Implicit in all of this was the fantasy that all doctors were practicing optimal caregiving and all hospitals were uniformly motivated to do what was right for patients, not what was most convenient and financially beneficial for the hospitals themselves.
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