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Related Concept Videos

Issues And Trends In Healthcare Delivery System01:29

Issues And Trends In Healthcare Delivery System

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The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
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Introduction To Health Care Delivery System01:18

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The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
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Patient-centered care involves delivering care beyond inpatient hospitalization. Reflective practice can enhance a patient-centered approach. Reflective practice is a process of reasoning that considers all aspects of the present situation, including practicalities, learning from personal practice, and consideration of patient needs. Patients appreciate care decisions made while considering their input. Involving the patient in their care provides the patient with a sense of contribution rather...
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Managed Care System:
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Health Information Technology (HIT)
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Integrated Healthcare System01:20

Integrated Healthcare System

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An integrated healthcare system (IHS) is a set of organizations that provides for or arranges to provide coordinated and continuous service to a defined population. The IHS takes responsibility for that particular population's health status and outcome, both clinically and fiscally. An integrated healthcare system is a well-organized, well-coordinated, and collaborative network. The integrated delivery system is a network that connects different healthcare providers to deliver organized,...
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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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The physician-insurer dynamic must shift to successfully implement value-based payments.

Roy A Beveridge1, Laura E Happe1, Mike Funk1

  • 1Humana Inc, United States.

Healthcare (Amsterdam, Netherlands)
|September 8, 2016
PubMed
Summary

Physician distrust of insurers hinders value-based healthcare. Building trust and partnership is crucial for implementing new payment models focused on quality over quantity.

Keywords:
Healthcare reimbursementInsurersPatient Protection and Affordable Care ActPhysiciansPopulation healthValue-based payments

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Area of Science:

  • Healthcare economics
  • Health services research
  • Medical informatics

Background:

  • The current healthcare system often creates financial conflicts between physicians and insurers.
  • Physician distrust in insurers is a significant barrier to adopting value-based care models.
  • Traditional transactional relationships impede progress in healthcare payment reform.

Purpose of the Study:

  • To explore the challenges and opportunities in shifting the insurer-provider relationship towards value-based arrangements.
  • To identify strategies for fostering trust between physicians and insurers.
  • To examine the role of data and analytics in supporting physician care strategies within value-based frameworks.

Main Methods:

  • Qualitative analysis of the historical insurer-physician financial dynamics.
  • Review of existing literature on value-based payment models and physician-insurer relationships.
  • Conceptual framework development for a partnership-based approach.

Main Results:

  • Long-standing financial misalignment has fostered physician distrust, obstructing value-based care adoption.
  • A philosophical agreement on quality over quantity does not automatically overcome practical implementation hurdles.
  • Insurers possess the capacity to provide data, systems, and analytics to guide physician care strategies.

Conclusions:

  • Transforming the insurer-provider relationship from transactional to a trusted partnership is essential.
  • Successful implementation of value-based payments necessitates collaborative efforts to overcome established systems.
  • Building trust is a prerequisite for aligning financial incentives with quality healthcare delivery.