Organizing the U.S. Health Care Delivery System for High Performance

Abstract

This report from The Commonwealth Fund Commission on a High Performance Health System examines fragmentation in our health care delivery system and offers policy recommendations to stimulate greater organization—established mechanisms for working across providers and care settings. Fragmentation fosters frustrating and dangerous patient experiences, especially for patients obtaining care from multiple providers in a variety of settings. It also leads to waste and duplication, hindering providers’ ability to deliver high-quality, efficient care. Moreover, our fragmented system rewards high-cost, intensive medical intervention over higher-value primary care, including preventive medicine and the management of chronic illness. The solutions are complex and will require new financial incentives, changes to the regulatory, professional, and educational environments, and support for new infrastructure. But as a nation, we can no longer tolerate the status quo of poor health system performance. Greater organization is a critical step on the path to higher performance. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff, or of The Commonwealth Fund Commission on a High Performance Health System or its members. This and other Fund publications are available online at www.commonwealthfund.org. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 1155. iii cOntentS List of Exhibits iv Preface v About the Authors vi Acknowledgments viii Executive Summary ix I. Background 1 II. How Do We Want Health Care to Be Delivered? 3 III. Is It Achievable? 8 Iv. What Do We Know About “Organization”? 16 v. Trends in Physician Organization 18 vI. How Will We Get the Care We Want? 20 vII. Policy Recommendations 29 vIII. Conclusion 31 Notes 33