America has an opportunity to change the business model for health and social service from payment for activities to payment for outcomes.
The current state and federal business model drives the production of service activities across multiple agencies with no measured accountability for specific outcomes and duplicative services. Initiatives across the country are developing strategies to change contractual accountability to the delivery of positive outcomes.
Recent national focus with collaboration from the Health Resources Services Administration, American Academy of Pediatrics, and business and health leaders, have identified three common characteristics of programs effectively improving outcomes;
Currently, there is no broad-based strategy to identify those most at risk. Populations at risk for catastrophic outcomes such as pregnancy, diabetes, hypertension, cardiovascular disease, and depression, enter our system through the emergency room only after progression of problems or disease. This results in complex, reactive, and expensive debilitation.
Beginning to change the contracting strategy from service activity to outcomes can be implemented, focusing on those populations most at most extreme risk. These initiatives through pilot projects and, in beginning steps, within state agencies, will improve outcomes for at risk individuals. Contracting for outcomes provides health improvement and financial data to assist the state in avoiding duplicity of services, improving service efficiency, and the health of our most at risk populations.
