Abstract
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined. If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. The role of patients within clinician-patient relationships would be elevated, strengthening therapeutic relationships. Reframing health in terms of health-related goals and directing the health care system to help people achieve them, could both improve quality and reduce costs. In the process, it could also make health care less mechanical and more humane.
Highlights
BackgroundWe are about three decades into a concerted effort on the part of government and industry to reform our health care system, primarily because it is so expensive, and because we have fallen behind other developed countries on most measures of population health
Recent improvement strategies have recognized the importance of primary care and have embraced the “Care Model,” developed by Ed Wagner and colleagues [1], and “Patient-Centered Medical Home" principles developed and adopted by the three major primary care professional associations [2]
Reformers are measuring the success of their efforts using the “Triple Aims,” a framework proposed by Donald Berwick, President Emeritus and Senior Fellow at the Institute for Healthcare Improvement and former Director of the Centers for Medicare and Medicaid Services
Summary
We are about three decades into a concerted effort on the part of government and industry to reform our health care system, primarily because it is so expensive, and because we have fallen behind other developed countries on most measures of population health. If the health care system suddenly switched from problem-oriented to goal-directed care, clinicians and patients would find that much of the information they would want is not available or has not been analyzed in such a way as to be helpful. Despite these formidable obstacles, there are some signs that such a transformation could happen, and is happening to some degree. Those things are most likely to include the rapid evolution of genomics, the renewed escalation of health care costs despite current cost control measures and the growing dissatisfaction of clinicians and their patients with the current approach
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