How the Right Combination of Local System Changes Could Substantially Improve Health and Lower Cost and Be Financially Self-Sustaining

Homer, Jack; Hirsch, Gary; Fisher, Elliott; and Milstein, Bobby. (2015).   How the Right Combination of Local System Changes Could Substantially Improve Health and Lower Cost and Be Financially Self-Sustaining. Working paper, ReThink Health. Health reform in the U.S. is a national priority that requires concerted action in every region across the country. Knowing that health and health care are shaped strongly by local conditions, researchers examine several strategy choices that local planners may pursue to influence health system performance over time. This report concentrates on five strategies in particular: (1) delivering high-value preventive and chronic care; (2) reinvesting savings from lower health care costs; (3) shifting provider payment from fee-for-service to contingent global payments; (4) enabling healthier behaviors and safer environments; and (5) expanding socioeconomic pathways to advantage for families. Authors estimate the relative and combined effects of these strategies using simulated scenarios from the ReThink Health Dynamics Model, configured with national data to represent a prototypical mid-sized American city. Results show the likely influence on cumulative measures of deaths, health care costs, inequity, workforce productivity, and program spending from 2012-2040. These scenarios suggest that a carefully crafted mix of clinical and social change initiatives, together with value-based payment and sustainable financing could significantly transform local health system performance.

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