Strategies of improving healthcare delivery have made an error of micromanaging providers' practices and controlling supply. Recent developments have seen the health plans try to predict the decisions of the providers. The benchmarks for value delivery have been a capital investment and raising the level of the service providers to acceptable levels. The practice guidelines, as well as the standards of care, have been the principal tools that each provider is expected to meet. Similarly, there has been an increase in the use of evidence-based medicine which is another term for practicing that is based on the standards of care that are regarded as acceptable. Continues use of quality and pay for performance efforts address the compliance to process rather than the quality of the expected results. Some of the initiatives assume that good must be expensive and therefore good performance must be rewarded using small price differentials leading to the increase of provider reimbursement. Guidelines that focus on the process are ideal to the providers as they can easily meet them. the entire process-oriented approach is misguided as the guidelines use the complexity of the circumstances of each patient while freezing care delivery processes as opposed to promoting innovations (Porter & Teisberg, 2006). In line with the ensuing discussion, this paper looks into delivering value in the healthcare. It will determine how the issue impacts on the delivery of healthcare, and describe two examples of organizations and management theories that are related to the topic. Similarly, it will establish the challenges raised by this topic to the healthcare managers and also the impacts of technology on the issue.
Background of the Problem
The assumptions that good quality healthcare is expensive is misguided and ill placed. It is evident from the industry that better providers are often effective. Good quality is not costly than illness given that it is associated with fewer treatment errors, accurate diagnosis, reduced complication rates, less invasive treatment and minimizes the need for treatment. Quality improvement should not lead to increased cost in that providers can earn higher margins at the same or even lower cost. Patients can be migrated to the efficient providers thus feeding to the virtuous circle of value improvement which can be achieved using a greater scale, deeper experience, improved efficiency, faster learning and dedicated teams and excellent facilities at the medical condition level. There are significant differences between the actual care that is delivered and the best practices in the U.S. There are increased cases of under and overtreatment. According to a recent RAND study that involved thirty types of preventive, chronic and acute care in 12 metropolitan areas, Americans on average receive only 55% of the care that is suggested by the established medical standards. Under treatment indicates quality problems and the defector rationing of care. The problems of disparities in the healthcare system are prevalent in minority groups and low-income earners who are susceptible to poor outcomes and high mortality rates. The under-provision f care is also evenly distributed across different types of treatment like preventive care, chronic and acute care. The underuse of care is growing in its use for counseling and conducting medical history as opposed to interventional procedures as well as medication (Porter & Teisberg, 2006).
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Value in Healthcare
The value of healthcare delivered is determ9ned by the patient health outcomes versus the dollars spent. The fundamental purpose of health care is to deliver high and improving value which is the only goal that unites the interest of all participants. Value improvement is the only solution that transforms healthcare and reduces the practices of shifting costs to the patients, service restriction and reduced provider compensation. Improvements in the value do not need incremental improvements but a proper restructuring of the healthcare delivery. The delivery approaches as used today are a clear demonstration of the legacy of medical science management practices, organizational structures and payment models that are obsolete.
Some of the practices like turning patients to consumers, capitation to control spending, raising costs without doing the same on the level of service and elimination of self-dealing and fraud have had limited impacts. Other practices that have not had any meaningful effect on healthcare includes the elimination of errors, evidence-based medicine or clinical effectiveness research or guidelines, care coordinators, low-cost models for primary care and electronic medical.
Creating the right form of competition involves patient choices and competing for patients thus encouraging continuous improvements in the restructuring and value of the healthcare. One challenge that the healthcare is facing is that competition is not aligned with value. There is a need therefore to create positive-sum competition on the value for the patient. Value is a ratio of the health outcome that matters to a patient against the cost of delivering such outcomes. It is the measure of the care for a patient's medical condition throughout the full cycle of care. The outcomes are the complete set of results for the conditions of the patient. The costs involve all expenditures of care for the condition of the patient.
The management of value delivery in the healthcare calls for client-focused management practices using human relations theory and system theory where the focus will be on meeting the expectations of all stakeholders while ensuring that the entire process works seamlessly to achieve the desired goals. Creating value-based healthcare delivery system requires that care is organized to integrated practice units which are based on the patient's medical conditions. In this case, primary and preventive care should be organized to serve unique patient segments. The outcomes and costs for every patient should be measured. All payments for the care cycle should be bundled and care delivery systems should also be integrated. It is prudent to expand the geographic reach. Establish an enabling IT platform.
Some of the models that can be used in this case include; organizing by specialty and discrete service and organizing into integrated practice units. Some of the attributes of integrated practice units are as follows. They are organized around closely related conditions where care is delivered by a multidisciplinary high dedicated team who devote most of their time to the condition. The team sees itself as part of a common organizational unit. The team is responsible for the full cycle of care including outpatient, inpatient, rehabilitative and support services. The education of the patient, their engagement and even follow up and secondary prevention are integrated to care. Have a single scheduling and administrative structure, the care is co-located in one or more dedicated sites. A team captain or clinical care manager is responsible for the care process of each patient. Common measurement platforms are used by the team to measure cost, outcome, and processes for each patient. The providers who are in the team meet regularly both formally and informally where they discuss the patients, results, and processes. Joint accountability is acceptable for the costs and outcomes. Volume and experience have a higher impact on the value of healthcare in an IPU structure than in other systems (Scott, 2015).
Some of the cost reduction opportunities in the Healthcare includes reduced process variation which increases inventory, lowers efficiency and does not improve the outcome. Low or non-value added services or tests should be eliminated. Redundant administrative and scheduling units should be rationalized. Expensive physicians, staff, spaces and facilities utilization should be improved by eliminating duplication and fragmentation of services. the use of physicians and skilled staff should be minimized. The use of highly resourced facilities for the provision of uncomplicated services should be reduced. Cycle times should also be reduced. The total care cycle cost should be optimized while minimizing the cost of individual services. Cost awareness in the clinical team should be enhanced. Adopting cost reduction opportunities have the potential to improve outcomes (Scott, 2015).
Some of the major challenges faced by healthcare managers include the integration of the different stakeholders and encouraging a paradigm shift towards delivering value as opposed to heavy investments to increase the quality. Managers have an uphill task to manage the entire process and ensure that everything works seamlessly. Sharing of information is also another challenge that the managers will be forced to handle. Most entities are unwilling to disclose their costing techniques for fear of exposing some practices that can be regarded as self-enriching and non-value adding. Some of the activities and services in the care cycle are intended to justify billing and therefore it is difficult for the manager to identify such practices or eliminate them (Scott, 2015).
Information technology can be used to restructure the delivery of care and for the measurement of results. The IT should have common data definitions and must combine the different types of data that capture the entire care cycle including referring entities, access for every patient. It should also enhance communication and access to all parties involved including the patient. Templates for different medical conditions can be used to enhance the interface. It should use structured data or free text. It can include an architecture that enables the extraction of process measures, outcome measures, and activity-based cost measures for different medical conditions and patients. It also enhances interoperability standards that enable communication by different providers and organizations (Scott, 2015).
References
Porter, M., & Teisberg, E. (2006). Redefining health care . Boston, Mass.: Harvard Business School Press.
Scott, A. (2015). Towards Value-Based Health Care in Medicare. Australian Economic Review , 48 (3), 305-313. http://dx.doi.org/10.1111/1467-8462.12121
