Health System Transformation
Resources for Health Departments
The US health system is undergoing a critical transformation in both financing and service delivery. This site offers information, resources, and training opportunities related to these changes, with an emphasis on how they affect state, tribal, local, and territorial health agencies.
Healthcare financing is moving away from a fee-for-service reimbursement system, where providers are paid based on the volume of services they provide, to one that is based on the outcome or value of service, that is, a value-based healthcare purchasing system. A value-based purchasing system holds providers accountable for the care they provide and puts some of their revenue at risk, meaning they can receive less revenue for poor outcomes and more revenue for better outcomes.
The healthcare financing system involves both the public and private sectors. In general, Medicare, Medicaid, and the Children’s Health Insurance Program provide public sector financing, while health plans and businesses that purchase health care for their employees make up the private sector.
Teleconference: Healthcare Financing: Follow the Money
April 30, 2013, 3:30–5:00 pm (EDT)
In this teleconference, representatives from the Centers for Medicaid and Medicare Services and CDC described the current model of healthcare financing, recent changes to the system, and how Medicaid waiver programs can be useful in advancing public health initiatives.
- Medicare, Medicaid, and CHIP: CMS National Training Program (PDF [2.05MB], PPT [3.75MB])
- Transcript [PDF - 146KB]
- Audio [MP3 - 15.6MB]
The US health system is undergoing a critical transformation as it shifts from volume- to value-based delivery. Market regulatory forces are driving alignment of physicians and hospitals using new structures, such as accountable care organizations (ACOs) and patient centered medical homes (PCMHs), via acquisition, physician groups, and joint ventures.
This shift has resulted in new implications and pressures affecting providers and health systems. The role that public health and state health agencies can take on is greater than ever before. Thus, it is imperative for public health officials to develop a foundation of understanding on the drivers, changes, and implications affecting providers and healthcare service delivery overall.
CDC hosted a webinar on June 20, 2013, to discuss these strategic changes in healthcare delivery and to provide details on value-based models.
Webinar: Trends in Care Delivery and Community Health
June 20, 2013, 3:30–5:00 pm (EDT)
In this webinar, speakers described strategic changes in healthcare delivery, including value-based delivery models. Representatives from state health agencies also shared their respective state’s experience with healthcare-delivery transformation efforts. Participants were given the opportunity to ask questions of public health and healthcare experts.
- Trends in Care Delivery and Community Health [PDF - 2.25MB]
- Trends in Care Delivery and Community Health Meeting Summary [PDF - 276KB]
As the primary reimbursement model for healthcare services, health insurance is a critical topic for public health professionals to understand, including how it’s structured and how profit is made. The Affordable Care Act (ACA) expands the availability of health insurance by increasing access to coverage for many currently uninsured or underinsured Americans via the new Health Insurance Marketplace as well as through expansion of Medicaid in many states.
Webinar: Health Insurance Markets Overview
August 15, 2013, 3:30–5:00 pm (EDT)
In this webinar, speakers outlined the key components of health insurance and the upcoming changes brought about by the ACA. A subject matter expert from CDC provided information about public health agencies’ role in the ACA and insurance marketplace. Additionally, the Commissioner from the Vermont Department of Health shared Vermont’s experience engaging with the health insurance market.