COORDINATED EFFORT Health care systems readjust on heels of Obamacare, move to integrated care and fee for value

The health care industry this year underwent a dramatic change as it weathered through the integral stages of the most historic piece of federal health care reform since Medicare in the 1960s.

The health care industry this year underwent a dramatic change as it weathered through the integral stages of the most historic piece of federal health care reform since Medicare in the 1960s.

In the forefront of many businesspersons’ minds, the adjustments and changes rate as one of the top business stories in the Greater Lehigh Valley.

The 2010 law, the Affordable Care Act – or Obamacare – had its most significant reforms implemented at the beginning of this year, when millions of Americans enrolled in mandated federal or employee-sponsored health care coverage – or risked the consequences of federal fines.

This historic overhaul means consumers may be forced to pay more out-of-pocket for their health care coverage – prompting hospitals and health networks to adopt a coordinated-care, team-centered business model, shifting from “fee for service” to “fee for value.”

“In a nutshell, coordinated care has to deliver value. That means higher quality care at a lower cost,” said Tom Croyle, president of Lehigh Valley Business Coalition on Healthcare, which strives to improve the delivery, cost and quality of health care in the region. “We have to get rid of the fragmentation, inefficiencies and wide variations in both cost and quality inherent in our current system.”

In this new model of health care, the role of the primary care physician has shifted.

Physicians will now be more of a captain for a patient’s entire team of health care professionals – ensuring that communication and services for each patient remain constant — to create a smooth and seamless coordination of care.

To respond to this concept, St. Luke’s University Health Network, for example, had transitioned five of its primary care offices to patient-centered medical homes by October. Hoping to increase efficiency, the goal is to bring the vast majority of the network’s 80 primary care and specialty physician practices into the model by the first quarter of 2015.

“ … We have accomplished a great deal with regard to better coordinating the care of our patients across the delivery system,” said Dean Evans, president, St. Luke’s Physician Group. “The plan to connect care coordinators from all parts of our network, as well as with non-network-employed providers and facilities – both electronically as well as functionally – is well underway.”

Instead of focusing on treating the patient upon diagnosis, as the traditional model of health care demands, the new coordinated effort focuses more on the entire picture of health for a patient, including preventive care.

Jennifer Glose
Reporter Jennifer Glose covers health care, Berks County and other topics. She can be reached at jenniferg@lvb.com or 610-807-9619, ext. 111.

LVB Business Events

2019 Health Care Symposium

Thursday, August 01, 2019
2019 Health Care Symposium

2019 CFO of the Year Awards

Wednesday, September 11, 2019
2019 CFO of the Year Awards

HR Symposium

Wednesday, September 25, 2019
HR Symposium

2019 Fastest Growing Companies Awards

Wednesday, October 23, 2019
2019 Fastest Growing Companies Awards