Many political leaders, business leaders, and patients say that when it comes to healthcare “we are not getting what we pay for.”  When asked, they mean we are paying great sums of money for mediocre national statistics in patient outcomes, access, safety, service, patient satisfaction, and overall US population health. The unfortunate reality is we are getting exactly what we pay for due to the incentives in our predominant healthcare payment model of fee for service, price controls, and relative value units (RVUs) as well as the long-term lesser focus on and funding for public health, prevention, and health promotion.  

The stakeholders in the healthcare delivery system have, over the past 45+ years, self-organized to maximize their own sector by designing way to capitalize on fee for service (the system gets paid when people are sick, not when they are well or healthy). Price controls may lower the process but does nothing to control utilization of services or reduce waste. RVUs guarantee the US has many specialists but few doctors focused on primary, secondary, and tertiary care models to keep people as healthy, well, and functioning as possible. Lacking is a collective realization that we cannot tackle the difficult problems faced in US health and healthcare unless we develop partnerships across sectors, engage in collaborative work, and share a vision of enhancing health and well-being across patients and communities.

Our mission is to promote high value healthcare and the attainment of health. The parameters of this value equation can include any or all of the following: Numerator – outcomes, safety, service, access, patient functionality, rate of cure, wellness when cure is not possible, comfort at end of life compared to the Denominator – actual spending over time, utilization rates.

To attain high value healthcare and health, there must be a change in payment models from one that pays best when we are sick to one that pays best to keep us well.  This must be a model that prioritizes prevention, health promotion, and wellness. In addition, a model that pays in such a way that keeps the very best healthcare providers in business, so they are available to provide high value care for patients and their communities. 

This is a long-term mission with many barriers due to a lack of a National Vision for health and healthcare. Political self-interests in power and control have advanced to the point that our country cannot even accomplish the easiest of all the healthcare tasks – insurance for all. Nor has our country coalesced around a path forward to improve US population health.

The Center for Healthcare Delivery, and Policy conducts research and educates students in these important areas and works to bring siloed groups together to work collaboratively with a shared vision for better health and healthcare delivery in the US. This is fundamental for our country.

Denis Cortese 
Director, Center for Healthcare Delivery and Policy