Restructuring the U.S. health care delivery system to provide the kind of coordinated, patient-centered care that high-quality medical care organizations are now achieving will require new organizational arrangements, strong primary care and effective team performance.
Most people agree on the need to increase the U.S. health care system’s capacity to provide coordinated and patient-centered care. Care organizations such as the Mayo Clinic and Kaiser-Permanente are often cited as exemplary models for how they monitor patient needs and outcomes and contain costs. This commentary argues that these models are unlikely to be replicated on a large scale because they are poorly matched to the existing distribution of small medical practices. Reorganizing the provision of medical care will require changing not only remuneration schemes, but also the norms and culture of the work of physicians and other professionals.
- Strong leadership and focus on mission.
- Good measures and feedback of results, including clinical quality indicators.
- Tools for care coordination, including an outstanding clinical information system.
- A culture of teamwork, coordination and collaboration.
Building care organizations that can achieve clinical integration across the continuum of illness is a formidable task given the current dearth of large multispecialty groups. The author advocates building on existing models of hospital medical staff and insurance networks. Innovative approaches to primary care are needed, along with new ideas for how physicians and other primary care clinicians can be educated to work together effectively.