A clinical and economic perspective on head injury rehabilitation

It has been demonstrated that comprehensive rehabilitation, delivered in an aggressive manner throughout the continuum of levels of care, produces optimal outcomes and associated savings in health care resource consumption. The current delivery and reimbursement systems, however, are not structured to encourage maximal utilization of this method of care delivery. Areas of concern include inexpert providers, lack of objective data regarding the care process and outcome, lack of effective clinical review, and a payment system that promotes excess utilization of services. A model delivery and reimbursement system is described that addresses these Issues and has had some success in ameliorating these problematic areas. The model includes the use of a national expert provider network, prospectively generated objective clinical and cost data, and a risk-sharing reimbursement methodology.