The impact on value of IPUs is striking. Those days are over. “Doctors will educate their patients more often about … There is no longer any doubt about how to increase the value of care. Corpus ID: 167036960. Clinicians and administrators battle over arbitrary cuts, rather than working together to improve the value of care. Patients with low back pain call one central phone number (206-41-SPINE), and most can be seen the same day. “Moving to a high-value health care delivery system has six components that are interdependent and mutually reinforcing,” state Porter and Lee. Reputations that are based on perception, not actual outcomes, will fade. Hospitals with private-practice physicians will have to learn to function as a team to remain viable. New models of delivering routine primary care in lower-cost settings (such as retail clinics) have a role, but they will do little to address the bulk of health care costs, most of which are generated by care for more-complex diseases. Maintaining current cost structures and prices in the face of greater transparency and falling reimbursement levels will be untenable. © 2020 SurgeonCheck LLC. Those organizations—large and small, community and academic—that can master the value agenda will be rewarded with financial viability and the only kind of reputation that should matter in health care—excellence in outcomes and pride in the value they deliver. The current structure of health care delivery has been sustained for decades because it has rested on its own set of mutually reinforcing elements: organization by specialty with independent private-practice physicians; measurement of “quality” defined as process compliance; cost accounting driven not by costs but by charges; fee-for-service payments by specialty with rampant cross-subsidies; delivery systems with duplicative service lines and little integration; fragmentation of patient populations such that most providers do not have critical masses of patients with a given medical condition; siloed IT systems around medical specialties; and others. For most providers, creating IPUs and measuring outcomes and costs should take the lead. Such systems also give patients the ability to report outcomes on their care, not only after their care is completed but also during care, to enable better clinical decisions. Sophisticated employers have learned that they must move beyond cost containment and health promotion measures, such as co-pays and on-site health and wellness facilities, and become a greater force in rewarding high-value providers with more patients. Measuring outcomes is likely to be the first step in focusing everyone’s attention on what matters most.All stakeholders in health care have essential roles to play. Reducing errors is essential, but errors are just one of the outcomes that matter to patients. IPUs not only provide treatment but also assume responsibility for engaging patients and their families in care—for instance, by providing education and counseling, encouraging adherence to treatment and prevention protocols, and supporting needed behavioral changes such as smoking cessation or weight loss. Efforts to reform health care have been hobbled by lack of clarity about the goal, or even by the pursuit of the wrong goal. This approach is already starting to be applied to high-risk, high-cost patients through so-called Patient-Centered Medical Homes. It’s time for a fundamentally new strategy. A common IT platform enables effective collaboration and coordination within IPU teams, while also making the extraction, comparison, and reporting of outcomes and cost data easier. Wherever IPUs exist, we find similar results—faster treatment, better outcomes, lower costs, and, usually, improving market share in the condition. Yet every other stakeholder in the health care system has a role to play. It is now moving toward giving patients full access to clinician notes—another way to improve care for patients. Over time, outcomes for standard cases at the Clinic’s affiliates have risen to approach its own outcomes. Geographic expansion takes two principle forms. With bundled prices in place, IPUs have stronger incentives to work as teams and to improve the value of care. Here’s how. We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need. HEDIS (the Healthcare Effectiveness Data and Information Set) scores consist entirely of process measures as well as easy-to-measure clinical indicators that fall well short of actual outcomes. Access to poor care is not the objective, nor is reducing cost at the expense of quality. Senior management estimates that 50% of comparable care currently still performed at the hub could move to satellite sites—a significant untapped value opportunity. In 2009, the city of London set out to improve survival and prospects for stroke patients by ensuring that patients were cared for by true IPUs—dedicated, state-of-the-art teams and facilities including neurologists who were expert in the care of stroke. With the tools to manage and reduce costs, providers will be able to maintain economic viability even as reimbursements plateau and eventually decline. As providers distribute services in the care cycle across locations, they must learn to tie together the patient’s care across these sites. As bundled payment models proliferate, the way in which care is delivered will be transformed. UCLA’s kidney transplant program, for example, has grown dramatically since pioneering a bundled price arrangement with Kaiser Permanente, in 1986, and offering the payment approach to all its payors shortly thereafter. In primary care, IPUs are multidisciplinary teams organized to serve groups of patients with similar primary and preventive care needs—for example, patients with complex chronic conditions such as diabetes, or disabled elderly patients. Instead, most hospital cost-accounting systems are department-based, not patient-based, and designed for billing of transactions reimbursed under fee-for-service contracts. In health care, that requires a shift from today’s siloed organization by specialty department and discrete service to organizing around the patient’s medical condition. Using the article "The Strategy That Will Fix Health Care" by Michael E. Porter and Thomas H. Lee please help with the following: (a) Include a background statement to introduce what you will write about. How to Solve the Cost Crisis in Health Care. At Dartmouth-Hitchcock’s Spine Center, for instance, patient scores for pain, physical function, and disability for surgical and nonsurgical treatment at three, six, 12, and 24 months are now published for each type of low back disorder. Just as railroads converged on standard track widths and the telecommunications industry on standards to allow data exchange, health care providers globally should consistently measure outcomes by condition to enable universal comparison and stimulate rapid improvement. Here is a quick summary: The goal is ‘value’ Different patient groups require different teams, different types of services, and even different locations of care. As a result, the cost of measuring outcomes and costs is unnecessarily increased. The stated promise of consumer-oriented health care—“We do everything you need close to your home or workplace”—has been a good marketing pitch but a poor strategy for creating value. A recent study of the relationship between hospital volume and operative mortality for high-risk types of cancer surgery, for example, found that as hospital volumes rose, the chances of a patient’s dying as a result of the surgery fell by as much as 67%. Unfortunately, most multisite organizations are not true delivery systems, at least thus far, but loose confederations of largely stand-alone units that often duplicate services. Hybrid models include the approach taken by MD Anderson in its regional satellite program, which leases outpatient facilities located on community hospital campuses and utilizes those hospitals’ operating rooms and other inpatient and ancillary services as needed. The clinic sees about 2,300 new patients per year compared with 1,404 under the old system, and it does so in the same space and with the same number of staff members. We must shift the focus from the volume and profitability of services provided—physician visits, hospitalizations, procedures, and tests—to the patient outcomes achieved. In many cases, current reimbursement schemes still reward providers for performing services in a hospital setting, offering even higher payments if the hospital is an academic medical center—another example of how existing reimbursement models have worked against value. Tier 1 involves the health status achieved. Healthcare will need to be technologically enabled, with comprehensive electronic health record systems, patient access to medical information, and the ability to obtain care using mobile and video technologies. Providers that cling to today’s broken system will become dinosaurs. Virginia Mason did not address the problem of chaotic care by hiring coordinators to help patients navigate the existing system—a “solution” that does not work. The Strategy That Will Fix Health Care – Harvard Business Review . Other patients will require surgery and will enter a process for that. Listen to The Strategy That Will Fix Health Care (Harvard Business Review) Audiobook by Michael E. Porter, Thomas H. Lee, narrated by Todd Mundt By its very nature, primary care is holistic, concerned with all the health circumstances and needs of a patient. Rising health care expenses have created enormous amounts of pressure in the health care system. Virginia Mason has also increased revenue through increased productivity, rather than depending on more fee-for-service visits to drive revenue from unneeded or duplicative tests and care. There is no longer any doubt about how to increase the value of care. For example, high readmission rates and frequent emergency-department “bounce backs” may not actually worsen long-term survival, but they are expensive and frustrating for both providers and patients. Since then, through our research and the work of thousands of health care leaders and academic researchers around the world, the tools to implement the agenda have been developed, and their deployment by providers and other organizations is rapidly spreading. The first principle in structuring any organization or business is to organize around the customer and the need. Big Med - Quality Control for Patients Everywhere. If they can improve the efficiency of providing excellent care, they will enter any contracting discussion from a position of strength. Duplication of effort, delays, and inefficiency is almost inevitable. U.S. government payors (Medicare and Medicaid) raise payment levels each year minimally, if at all. Is this “The” strategy that will fix health care? 8) A physician team captain or a clinical care manager (or both) oversees each patient’s care process. A welcomed competition is emerging to be the most comprehensive and transparent provider in measuring outcomes. Contrast that with the approach taken by the IPU at Virginia Mason Medical Center, in Seattle. If complications occur whose effective management is beyond the ability of the satellite facility, the patient’s care is transferred to the hub. Global capitation, a single payment to cover all of a patient’s needs, rewards providers for spending less but not specifically for improving outcomes or value. Clinicians must prioritize patients’ needs and patient value over the desire to maintain their traditional autonomy and practice patterns. These developments are not unique to the United States: A similar story is playing out in virtually every national health care system across the globe. Patient-centered system organized around patient need. 91 no. Outcomes should be measured by medical condition (such as diabetes), not by specialty (podiatry) or intervention (eye examination). It is a journey that providers embark on, starting with the adoption of the goal of value, a culture of patients first, and the expectation of constant, measurable improvement. Satellites deliver less complicated care, with complex cases referred to the hub. They meet frequently, formally and informally, and review data on their own performance. That’s because IT is just a tool; automating broken service-delivery processes only gets you more-efficient broken processes. For academic medical centers, which have more heavily resourced facilities and staff, this may mean minimizing routine service lines and creating partnerships or affiliations with lower-cost community providers in those fields. If providers can improve patient outcomes, they can sustain or grow their market share. The six components of the value agenda are distinct but mutually reinforcing. Sound bundled payment models should include: severity adjustments or eligibility only for qualifying patients; care guarantees that hold the provider responsible for avoidable complications, such as infections after surgery; stop-loss provisions that mitigate the risk of unusually high-cost events; and mandatory outcomes reporting. This payment model also exposes providers to risks over which they have little control. 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