his very first patient shocked him by refusing the moderately expensive but effective treatment he prescribed for her cancer—a choice that turns out to be common among patients in Singapore, who like to pass the money in their government-mandated health-care savings accounts on to their children

“value-based care,” which rewards providers who keep costs down while achieving good outcomes, is not going well

As with other forms of value-based health care, patient-centered care requires a shift in the way provider practices and health systems are designed, managed, and reimbursed. In keeping with the tenets of patient-centeredness, this shift neither happens in a vacuum, it driven by traditional hierarchies in which providers or clinicians are the lone authority. Everyone, from the parking valet and environmental services staff to c-suite members, are engaged in the process, which impacts hiring, training, leadership style, and organizational culture. Patient-centered care also represents a shift in the traditional roles of patients and their families from one of passive “order taker” to one of active “team member.” One of the country’s leading proponents of patient-centered care, Dr. James Rickert, has stated that one of the basic tenets of patient-centered care is that “patients know best how well their health providers are meeting their needs.” To that end, many providers are implementing patient satisfaction surveys, patient and family advisory councils, and focus groups, and using the resulting information to continuously improve the way health care facilities and provider practices are designed, managed, and maintained from both a physical and operational perspective so they become centered more on the individual person than on a checklist of services provided. As the popularity of patient- and family-centered health care increases, it is expected that patients will become more engaged and satisfied with the delivery of their care, and evidence of its clinical efficacy should continue to mount.

First, the industry is demanding it. Those who are paying for healthcare—the government, employers, patients, commercial health plans—want more value for their healthcare dollar. The transaction-driven, fee-for-service model has helped contribute to a fragmented healthcare system that has led to major challenges in healthcare. This fee-for-service model is simply not sustainable.

reliability and accessibility of big data will help facilitate increased reliance upon outcomes-based contracting and alternative payment models.

fee-for-service payment models to value-based care