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Systems Engineering and Health Care Reform - Boston

18 July 2014       Bookmark and Share

By: Scott M. Zanolli and William M. Mandell, Esq.

While reasonable minds may debate the methodologies and cost shifting associated with the Affordable Care Act, it is undeniable that millions of individuals have gained access to the health care system this year as a result of its implementation.  Increased access brings many challenges for professionals at all levels to provide high quality care that focuses first on the needs of individual patients and their families.

In a provocative article published in the Journal of the American Medical Association on Monday, Doctors Christine K. Cassel and Robert S. Saunders argue that the health care system needs to aggressively implement systems engineering in order to improve efficiency and reliability.  They note growing traction for the concept, as the President’s Counsel of Advisors on Science and Technology (“PCAST”) recently issued a report describing systems engineering tools for health care in detail, but also noting significant impediments to implementation, especially in rural and small practice settings.

The PCAST makes a variety of recommendations, including payment incentives that are tied to outcomes (as opposed to the current predominant fee for service system); increased access to health data and analytics, including vast pools collected by the U.S. Department of Health and Human Services; greater technical assistance in systems engineering approaches especially for small practices; and encouraging Accountable Care Organizations to collaborate more broadly with community health organizations and other providers outside of their traditional sectors.

The authors conclude that health care delivery transformation is essential to achieving the primary goals of affordability, quality and creating healthy communities.  As the Affordable Care Act is further implemented over the next several years, systems engineering science, broadly supported by the Federal government, is likely to become a core function for improving the health care delivery system. Moreover, as reform begins to transform the insurance driven aspects of the system, improved quality and coordination of care imperatives will likely motivate physicians, medical groups, hospitals and other providers to explore new types of contracting relationships, integration and expansion strategies.  Massachusetts continues to be at the forefront of these developments, having implemented health care reform well ahead of the Affordable Care Act.

Read the Cassell/Sanders article, and check out the PCAST recommendations.

Lawyers in Pierce & Mandell’s Health Law Department provide creative, effective advice to hospitals, physicians, medical practices and professionals on a broad range of business, compliance and litigation matters. www.piercemandell.com/health-law.html.

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