Value-Based Health Care Delivery

Value-based delivery principles have a series of implications for providers that I have begun to describe. Providers need to reorganize around IPUs, decide what services to offer in each facility, and integrate care in IPUs across geographic locations. To work effectively with other entities in the care cycle, providers need to move beyond arm's-length relationships and forge partnerships that enable integrated care. Providers should limit services to those areas where they can deliver true excellence, and expand excellent services geographically rather than think of themselves as local organizations. Most providers will offer a range of services, including broad line medical centers. However, care delivery in each service area will be organized and managed completely differently. Measurement of outcomes and costs is essential to value improvement, with or without external requirements. Finally, providers need to begin to contract differently. None of these principles of value-based health care delivery is theoretical, but have already begun to be implemented in a growing number of organizations in the United States and other countries. MD Anderson Cancer Center, whose transformation is described by Dr. Raphael Pollock in this issue of the Annals of Surgery, offers an advanced and powerful example of value-based health care delivery in practice. Providers need not wait for new regulations or outside forces to move in this direction. Every provider can start down the path of value-based health care delivery and will benefit even if other system participants are slow to follow. Copyright © 2008 by Lippincott Williams & Wilkins.