Week three discussion replies. Please respond to the
TWO students post below.
Janelle Ferrer
In the video, Michael Porter discusses “Value-Based Health Care Delivery.” He defines success as reducing the healthcare burden on people and the community through improving and delivering high-value healthcare. The goal is to restructure care organizations around patient conditions, outcome and cost measurements, payment models, and health system strategy through improving information technology
(Harvard Business School, 2012).
Understanding patient preferences and health issues are crucial to creating a better patient experience. There is a need for a system that will be rewarded in improved value rather than by volume, therefore changing the basis of competition will make much difference in improving patient outcomes in the most cost-effective way. It’s invaluable for the organization to know how its patients perceive healthcare services and for providers to connect with patients throughout the whole process of care. Focusing on the outcomes that matter most to patients, value aligns care (Teisberg, Wallace & Ohara, 2022). In addition, Michael Porters mentions in the video the need to modify payment to a bundled payment which is a total package of services for primary care. A 2018 pilot study tested the feasibility of a 1-year bundled payment for the multidisciplinary treatment of head and neck cancers, showing that it offered greater financial certainty (Spinks et al., 2018).
Successful healthcare deliveries result from an effective organization. Since every patient’s case is unique, Michael Poters also talks about reorganizing how we deliver care and the services we provide. This strategy helps to maintain open communication with all providers, set clear roles, maintain awareness of potential internal and external conflicts, and take action to resolve them. Michael Porter talks about shifting away from increasing volume to increasing value through a clinically integrated care delivery system, where care is organized by condition and involves a multi-disciplinary team (Harvard Business School, 2012). It is essential to organize, make fair decisions, and utilize a precise delivery method to assign staff to their respective roles. Ensure that everyone is on the same page and that the team clearly understands their roles and the organization’s goals. Effective leaders can move employees around to ensure that they are making progress in meeting the company’s goals. Committing to reducing unwarranted variation can improve health outcomes and help to deliver a financially sustainable health system. It is all a matter of organizing jobs and assigning responsibilities aligned with their knowledge and ability. They can accomplish so much together by promoting the desired vision and shared perspective. At the same time, public health policies require coordination and collaboration to reinforce value improvement.
References
Harvard Business School. (2012, March 20).
Michael Porter on “Value Based Health Care Delivery” [Video]. YouTube. https://www.youtube.com/watch?v=DRkhppxZzL0
Spinks, T., Guzman, A., Beadle, B. M., Lee, S., Jones, D., Walters, R., Incalcaterra, J., Hanna, E., Hessel, A., Weber, R., Denney, S., Newcomer, L., & Feeley, T. W. (2018). Development and feasibility of bundled payments for the multidisciplinary treatment of head and neck cancer: A pilot program.
Journal of Oncology Practice,
14(2). https://doi.org/10.1200/jop.2017.027029
Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care.
Academic Medicine,
95(5), 682–685. https://doi.org/10.1097/acm.0000000000003122
Courtney Sheppard
Michael Porter argues that the value of care in healthcare organizations should increase. Value is outcomes over cost, and it is a measure of outcomes as they relate to the cost of outcomes. In today’s healthcare system, there is no reward for improving value, however, Michael Porter argues that it is vital to improve value in healthcare. Values that are relevant to patients are dependent on the problems those patients face. For example, a diabetes patient and a cancer patient are going to have different outcomes than each other. Cost is an important factor, because outcomes are not able to be achieved if there is no money to get there. To improve the value of an organization, either cost or outcomes need to be improved. Michael Porter argues that it is more important to improve outcomes, and an improvement in cost will follow. The belief that it is expensive to provide quality care, or that technology and innovation come at a high cost are untrue. Michael Porter reports that some of the best hospitals with the best outcomes operate at a low cost (Harvard Business School, 2012).
Michael Porter also reports six steps to improve value in health care. The first step is to reorganize the way care is delivered. The current healthcare system is organized around services and tools, and not the patient. The second step is to measure outcomes and costs for every patient as they are receiving care. The third step is to use a bundled payment system to pay for the whole problem, instead of fee-for-service. This would align payment with value, because the whole team would need to give valuable care, from the surgeon to the post-care team, to be able to pay for the care they give. The fourth step is to create integrated healthcare systems to allow patients to receive the best care. For example, if one facility offers amazing surgery and another offers great physical therapy, a patient should be able to use both resources. This would be easier if the delivery systems were integrated. The fifth step is to expand world class hospitals across the nation. This would allow people who currently only have access to rural hospitals to have access to high quality health care, technology, and innovation. The last step to improve value is to improve health information technology platforms (Harvard Business School, 2012).
Michael Porter also discussed how there are similar delivery system problems around the world. In Germany, the healthcare model is around services and specialties. If a person was experiencing headaches or migraines, they would first go to a primary care physician. If this physician could not help them, they would go through the system, experience delays at every step, and having to go through the administrative process at each step. Every visit is a different interaction, where they need to fill out new paperwork, figure out their scheduling, and meet different people, even if they are within the same hospital. This system also does not have a lot of coordination between providers, as there is no easy way to coordinate and figure out the problem and how to fix it. The physicians in this structure were unable to provide high value care, no matter how hard they worked. To address these problems, the system needs to be organized around the patient. If a patient goes to a primary care physician about a headache, they would be sent to a headache center, where they could access all their necessary care. This center had neurologists, physical therapists, and other providers to help with their issues, and patients only needed to see a central administrative process. This center saw a large improvement in value, and eventually were able to create affiliations, such as with imaging centers, to expand care. Outcomes were drastically improved, and they saw almost zero individuals with negative outcomes, and the cost lowered about 25% (Harvard Business School, 2012).
In the current system, patients with the same conditions are all treated as exceptions and are treated as if they are completely different cases. Currently, physicians see small amounts of the patients with the same conditions, which forces them to treat patients this way. However, dedicated teams allow physicians to deal with patients that are exceptions separately and have teams that are well versed in condition. Dedicated centers and teams can see large volumes of patients with the same condition, so they are able to become experts and provide high value care (Harvard Business School, 2012).
All outcomes are tiered, and providers must look at a multitude of outcomes for each condition. For example, in head and neck cancer, a physician would have to see if a patient survived, if they were able to speak, if they were able to eat, if they looked different, if they were able to return to a normal life, and many other outcomes. Measuring outcomes teach providers how to improve the care they give. For example, in organ transplants, outcomes are always measured. One measure that is taken is one year graft survival, and physicians are discord on if they were better or worse than average survival rates. These scores are not able to be compared statistically, but these outcomes allow providers to see how outcomes change over years. After these outcomes were shown, they improved the following year. This is because providers were able to see who was doing well and who was underperforming, and this made them learn and improve (Harvard Business School, 2012).
References
Harvard Business School. (2012, March 20).
Michael Porter on “Value Based Health Care Delivery” [Video]. Retrieved from https://www.youtube.com/watch?v=DRkhppxZzL0
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