Care Systems (South Dakota)
In the Patient Choice program, groups of physicians, hospitals and other health care providers and facilities align themselves into customized networks called “Care Systems” that work together to serve you.
Care Systems are free to organize and operate in ways that they think are best for providing health care to you. Each Care System is responsible for meeting patient needs, implementing its own quality improvement programs to improve the health and well-being of patients and making care management decisions.
As a health care consumer, competition is the key to making the health care marketplace work best for you. Care Systems are encouraged to compete for your business based on features such as:
- customer satisfaction
- cost
- quality of care
- clinical programs
- location
- other special services
To attract and retain your business, Care Systems must continually improve their services to you.
Care System Cost Groups
In the Patient Choice program Care Systems determine their own prices making them
accountable to you. Based on their prices and their effective use of resources, Care Systems fall into either a low or high cost group.
There may be several reasons for health care costs to vary from Care System to Care
System—operating expenses, facility costs, supplies, physician and staff salaries and fees for specialty services are just a few of the factors.
Cost groups are used to illustrate how Care System costs compare to one another. They do not signify higher- or lower-quality care or service.
If your employer bases your coverage contribution on cost group differences, you’ll want to consider the cost group your selected Care System falls into because it affects your cost for coverage and your flexibility in changing your selections. See the “Enrolling in Patient Choice” section for more information.
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Cost does not equal quality
A growing body of research shows that improving the quality
of car can lead to better outcomes and lower costs.
For example, lack of diabetic control is costly—more trips to
the ER, more hospitalizations. Conversely, closely monitoring
individuals with diabetes in an outpatient setting helps prevent
problems and promotes early intervention, which saves
money—and lives.
In the Patient Choice program, Care Systems that provide
quality care, with the fewest complications, can pass along
lower costs to you.
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