Health care in the U.S. is on the threshold of fundamental change. Powered by advances in federal policy, the underlying way in which we pay for health care is moving from the traditional fee-for-service, pay-for-volume historic approach to one that pays for demonstrated value. The way in which value is measured is still evolving, but risk-sharing, measuring the health status of populations, and coordinating care in order to improve effectiveness and reduce the total cost of care are the basic planks upon which this new environment is being built.
This next chapter of U.S. health care will require changes on several levels. For starters, the way physicians are organized is changing. Though still prominent elements of the landscape, small and solo practices are fading – sometimes by going out of business, sometimes by retirement, sometimes by being bought by health systems. What are growing are organized health delivery networks, either in consolidated centers or distributed in local practices in the community (but owned by, or affiliated with, larger, recognized institutions). The capital needs and staffing reconfiguration are things that are generally beyond the reach of smaller practices. Bringing on other care team members, beyond just the doctors – case managers, care coordinators, health educators, and numerous other new roles that have yet to fully emerge – generally just doesn’t work in smaller practices. This is particularly true in a fee-for-service environment, where the only way to get paid is to have face-to-face contact with doctors. In that setting, everything else is overhead .In a value-based setting, all that changes.