Keuzevak - Value based healthcare Flashcards
2 Core characteristics of Porter VBHC
Value chain; all activities of an organization must create a valuable product
- Create value for consumers
central premise: (in any industry) a successful and sustainable enterprise needs to create value for clients (in competition)
Outcomes
effects of care on the health status of patients
Costs
Value comparison and go with the cheaper one with the same value
Patient value;
health outcomes that matter divided by the costs to achieve those outcomes
Value is created
At the level of a medical condition over the full cycle of care
3 concepts in VBHC
- outcomes
- costs
- Value for patients
Medical condition level to create value
a) patients seek HC to address health-related issues
b) issues usually directly related to medical condition
c) ergo: professionals create value by looking at these conditions
Created at specific levels of care; lungcancer, skincancer and not cancer
Value is created over full cycle of care
a) value generated through a set of activities → value chain
b) full care cycle: from diagnosis to rehabilitation → start-to-end care
c) e.g surgery = 1 element of full care cycle
5 goals of VBHC!!
- organize into IPU
- Measure outcomes and costs for every patient
- Move to bundled payments for care cycles
- integrate care delivery across facilities
- Build and enable an IT platform
- expend the excellent services across geography
Measurement & reporting
Providers should measure outcomes and cost of their care cycles per patient
- Publicly reported (competition)
- enabling fair comparison
Systematic outcome measurement
Key Actions to Implement VBHC: 4 keys
- Organizing Around Care Cycles: Health care providers should be organized based on the full care cycle for medical conditions, not just by specialties.
- Integrated Practice Units (IPUs) that consist of multidisciplinary teams focusing on specific medical conditions.
- Measurement & Reporting: Providers should measure and report outcomes and costs for full care cycles, ensuring transparency for comparison.
- Payment Aligned with Value: A shift from fee-for-service to bundled payments that reward outcomes and efficiency, rather than volume of services provided.
Provider competition - value based competition
- Outcome Measurement: Systematic measurement allows for comparisons, and excellent providers are rewarded with more patients.
- Provider Incentives: Providers should be incentivized for achieving good outcomes and efficiency, not for providing more treatments.
Difference between hospital structure and VBHC principle
Hospitals; based on medical specialties
VBHC; per medical condition
IPU
multidisciplinary team of professionals and supporting staff are grouped together to coordinate their independent tasks with the overarching goal to improve value for a particular group of patients
- Hospitals should organize around medical conditions
Payment implication
Bundled payment; reimbursement for the whole care cycle of a medical condition
Rewarding good outcomes and efficiancy
- rewarding more patients
- financial bonusses; p4p
Providers that can not keep up
- Should restructure of go out of business
Confusion around IPUs
concepts refer to organizational units not to care paths
Multidisciplinary collaboration is common, IPU rare
Rare in Netherlands
- No own budget
- No own decision making
units in organization
refer to specific groups, departments, or divisions designed to handle particular functions or tasks.
You can achieve coordination within a unit in two ways-
- Lines of authority; coordination trough supervision decision making power
- Close contact; informal communication
function based grouping
- Vertical lines
- each line represents a group of people with a particular skillset and knowledge
- These groups are based on the means
Market based grouping or condition based grouping
- Each line represents a group (i.e. unit) that serve a particular market (hip replacement)
- serve along the whole cycle of care
- these units are group based on the ends of a production process
long tradition in hospitals and problems
- tradition of medical specialization
- with complex knowledge and skills
- Issues of coordination and dealing with interdependencies
(cross over all different IPU) - Outdaded legacies of medical specialization
Why IPU is solution
- coordination is value based (looked at the patient to provide care)
- to organize around customer needs, not the supply of particular services
VBHC Practical challenges IPU
- History and interest
- Public opinion (concentration of hospitals; specialized)
- radical vs incremental change; lot of time and effort
- informal collaboration vs formal reorganization
- MD teams as liaisons (between coordination mechanisms; work together to improve outcomes) vs. IPU as units