The Obama administration’s health care reform legislation will change incentives, which is badly needed, but it will not improve the quality of care unless an integrated, team-based approach also becomes the way health care professionals do business. This kind of approach is what the legislation refers to as ACO (accountable care organization). However, to be successful, such an approach will require health care professionals, especially doctors, to learn new competencies and form new attitudes regarding collaboration and cooperation.
The assumptions behind the new legislation make the need for change abundantly clear:
- the cost of health care in the United States on a per capita basis is too high
- the health of the United States population is too low
- health care in the United States is not sufficiently accessible, particularly for the uninsured
- health care in the United States is not sufficiently coordinated
- the quality of health care services in the United States is too low
- the federal government, as the largest purchaser of health care services in the United States, has the right to demand high quality, reasonably priced, accessible, coordinated health care services
- the federal government should no longer purchase health care services on a fee-for-service (or a la carte) basis because it gives health care providers an incentive to order more tests and perform more procedures in order to make more money
- there needs to be a “sea change” in how health care is delivered and paid for in the United States
Shifting from a fee-for-service model to a high-quality, low-cost model will address part of the problem. Don’t get me wrong - this change is essential, though the challenge with incentives is to ensure that “low-cost” doesn’t become more important than “high quality”. The other part of the problem is managing health care organizations in a fundamentally new way. Rather than the command-and-control style of leadership that is prevalent among doctors, nurses, and other health care professionals, these leaders will need to facilitate teamwork. They will need to respect and listen to the input of other health care providing organizations and integrate diet and life-style experts into the team. They will need to manage these teams so that optimum results are achieved for patients. They will need to keep all of the stakeholders engaged. They will need to draw out the best from everyone. And they will need to do all of this in a cost efficient manner. This is a tall order for people who come to their profession because of their high need for control, for prestige, and, for many, the financial benefits.
Health care professionals can be retrained if motivated. The real transformation of health care in the U.S. will come over time as a different kind of person is admitted to the health care professions and as measures are put in place to evaluate this team-based approach to delivering health care.