Health system

October 19, 2017

Global Budgets for Safety-Net Hospitals

Joshua M. Sharfstein, MD¹; Sule Gerovich, PhD²; David Chin, MD¹

Author Affiliations Article Information

JAMA. Published online October 19, 2017. doi:10.1001/jama.2017.14957

Investing in outpatient and community-based services can improve health and lower cost in the United States. Opportunities include enhancing primary care, expanding evidence-based behavioral health services, improving the coordination of care for patients with complex health needs, and linking patients to critical social resources. Yet because there is limited direct reimbursement for such efforts, major expansions depend on capturing savings. As a committee of the National Academy of Medicine recently noted: “In terms of sustainability, interventions that improve health and quality of care or reduce utilization and cost are only feasible to maintain if the provider is paid in such a way that profits (revenues minus costs) are higher with the intervention than without./.../”¹