The biggest challenge, for both the US and the NHS systems, is to design incentives that can support providers to coordinate care, ensuring that patients’ interests are followed as they cross between organisational boundaries.
In the United States, there are examples of such initiatives, such as the Alternative Quality Contract run by Blue Cross Blue Shield of Massachusetts, which gives physician groups a global budget and real time data to monitor what happens to their patients.
Early results from the scheme suggest that physicians have begun to change behavior by referring less and ensuring better value and quality for their patients. There is much optimism that other variants of this model will be successfully piloted as "accountable care organizations", as part of the health reform legislation.
Andrew Dreyfuss, Executive Vice President for Health Care Services, Blue Cross Blue Shield of Massachusetts, explains to Nuffield Trust Senior Fellow Ruth Thorlby how their initiative works.