Vast majority of participants support payment reform. 

A large percentage of participants in the latest Commonwealth Fund/Modern Healthcare survey want fundamental change in the way the U.S. healthcare delivery system is organized, the Commonwealth Fund says. The 14th Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey found that 89 percent of health experts surveyed favor such policies as strengthening the primary-care system, encouraging care coordination, and promoting care management of high-cost patients with complex conditions.

Eight percent said that only modest change is needed, and none of the experts want the U.S. healthcare system to remain as-is, the survey says. Only 3 percent claimed they were “not sure.”

The survey included 211 individuals in the fields of academia and research; healthcare delivery; business, insurance, and other health industries; and government, labor, and advocacy groups. Healthcare leaders gave their opinions about three aspects of the healthcare delivery system: organized delivery systems, patient-centered medical homes, and retail clinics.

The survey cited healthcare problems such as frustrating and dangerous patient experiences, waste and duplication, poor overall quality of care, and the use of high-cost, intense medical interventions rather than preventive medicine and chronic illness management.

Seventy-nine percent of those surveyed said that payment reform is needed to improve primary-care physicians’ ability to provide coordinated, high-quality care and to help prevent costly hospitalizations. Respondents said that payment reform should include a method of paying for the most appropriate care over an episode of illness or a year-long period rather than the current fee-for-service method, which “creates incentives to provide more and more services,” the survey said.

Changing the healthcare system through government regulation was considered “important” or “very important” by 79 percent of respondents, and 76 percent support collaboration between private payers and public payers.

When asked to rate methods of improving the performance of the health system, the experts rated four strategies as most important: strengthening the primary-care system (90 percent), encouraging care coordination (90 percent), promoting care management of high-cost patients with complex conditions (88 percent), and encouraging the integration and organization of providers (82 percent).

The experts also said they support providing supplemental payments for fee-for-service to primary-care physicians for delivering comprehensive, coordinated and accessible care (84 percent) and payment incentives for avoiding unnecessary hospitalizations and rehospitalizations (84 percent).

“The Commonwealth Fund’s Commission on a High-Performance Health System has called for reforms to reduce the fragmentation of care by linking physicians and hospitals into coherent organizations,” the survey says. When asked to compare organized healthcare systems to non-organized systems, 76 percent of survey respondents said that organized systems were more likely to provide high-quality care, 74 percent said organized systems were more likely to provide efficient care, and 57 percent said organized systems were more likely to provide patient-centered care. Eighty-eight percent of respondents said that integrated delivery systems (such as Kaiser Permanente) or large multi-specialty group practices were the best ways to achieve an organized system.

Other reforms that attracted support include special payment arrangements, such as capitation and episode-based payment (70 percent), and government aid for infrastructure (63 percent), especially information technology services (80 percent). Seventy-two percent of survey participants agreed that medical homes -- patient-centered, primary-care practices that offer accessible, coordinated, and continuous care -- would benefit U.S. healthcare.