Good healthcare is all about working together.
The drama and speculation surrounding the Affordable Care Act may well be distracting us from recognizing the front-line changes happening now--a wealth of innovative activity in communities across the country that are changing behavior on the ground and setting a new course for the future.
Despite the intensity of public conversation, there is wide acknowledgment at the grass roots of four major systemic challenges.
First, coordination: health care delivery is a team sport, and being better at combining both professionals and paraprofessionals--physicians, nurses, therapists, health aides, the people at the front desk, and myriad others--into high-performance teams can create the potential for better quality and more efficiency. Applying the same integrative concept to organizations--linking primary care with hospital, post-acute, and community-based care--provides the continuity that is now largely missing. Whether the terms are "medical homes," "accountable care organizations," or "health homes," or "coordinated care" for dual Medicare/Medicaid beneficiaries, the capacity to take responsibility for the totality of care is a key area of improvement.
Second, payment: There's near-universal agreement that paying a fee for each service is outmoded and counterproductive. Medicare moved to prospective payment for hospital admissions three decades ago. Whether we add a per-patient management fee in primary care, combine or bundle related hospital services, or provide full capitation to provider organizations, the idea that payment change should support service delivery change is taking hold. Payment arrangements, including private insurance contracts, can even incentivize and reward improved performance.