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

投资门诊和社区服务可以改善美国的健康状况并降低成本。机会包括加强初级保健，扩大基于证据的行为健康服务，改善对具有复杂健康需求的患者的护理协调，以及将患者与重要的社会资源联系起来。但是，由于此类工作的直接报销额有限，因此大规模的扩张取决于能否节省成本。正如美国国家医学科学院的一个委员会最近指出的那样：“就可持续性而言，只有提供者获得的利润（收益减去（费用）比没有干预的情况要高。” ^1个