The overarching goal of delivery system reform is to practice medicine in a new way to better find the value.
Better transparency and new financial incentives are certainly part of the solution set but it is likely that more will be needed. Delivery system reform includes a variety of approaches that attempt to deliver better health care in a more holistic fashion. Some common themes include changing the structure of the health care system to encourage quality and efficiency, reward care coordination among various health care, better sharing of information, often using health information technology, and improve patient and consumer engagement. Strategies include:
It can be hard to change practice patterns and provider culture and it is pretty certain that financial incentives are necessary but insufficient. Charismatic leadership, infrastructure and support for the transformation process itself are likely key elements in the success of delivery system reforms but we are still learning a lot about these dimensions. Local market conditions may also be integral to a successful intervention. And having a critical mass of payers all using the same methods of payment is critical.
Re-engineering health delivery systems is challenging. Providers often have to keep a foot in both the fee-for-service and value-based payment worlds.