Delivery Models in the Health Care

Introduction

To enjoy optimum health care as individuals and as a population, effectively coordinated high-quality healthcare services within a robust public healthcare infrastructure should exist. Healthcare delivery models are the primary building blocks of the structure and the processes involved in enabling consumers to receive health care. Unlike in the US, most first-world nations have national healthcare insurance plans operated by governments and funded through taxes. Almost everyone in those countries is eligible for routine and basic healthcare services. These forms of healthcare systems are referred to as universal access. Not all US citizens are eligible for basic and routine healthcare services. The country’s model has not been able to give access to its population to a basic healthcare package that is universal and affordable (Obucina et al., 2018). Developing innovative healthcare payment and delivery models is critical to the realization of improved quality of healthcare.

The Triple Aim

For healthcare systems to be successful, they should optimize costs, provide excellent quality of care, and ultimately improve the population’s health. This approach is referred to as the Institute of Health Improvement (IHI) Triple Aim, and its objective is to improve the population’s health (IHI, 2020). The main aims include:

• The reduction of per capita costs of healthcare
• The improved quality and satisfaction of care
• The advancement of the health of populations

The application of the IHI Triple Aim requires the creation of the proper basis for population management, the management of services for the citizens, and the establishment of learning systems to push and maintain the aims (Roy et al., 2017). The Triple Aim approach has been widely adopted because it is integral to the country’s national healthcare strategy.

Population health management initiatives are formulated and implemented to provide a sustainable healthcare system. Their focus is on the range of health and wellbeing of populations by providing initiatives that combine various services. Their success is premised on the achievement of the Triple Aim. The US recognized the value of the approach and adopted it as a way of taking care of deficits in the healthcare delivery model after implementing the Affordable Care Act (Obucina et al., 2018). Other developed countries have implemented the Triple Aim principles in their healthcare redesign.

Since its launching, the Triple Aim has emphasized the health of populations by focusing on improving equity of care and health outcomes, a shift to clinical quality instead of patient satisfaction, and a reduction of per capita cost. Healthcare organizations have also modified the framework to align with their own local priorities and strategic objectives. Interested parties have called for the consideration of the experience of healthcare suppliers, the involvement of the vital role contributed by people in healthcare delivery, and the expansion of the structure into a Quadruple Aim (Obucina et al., 2018). The population health dimension of the framework is described as the health outcome of a population, comprising the delivery of those results within a particular population. Mostly. Populations are often defined geographically but can constitute other clusters, including disabled persons, employees, and ethnic groups.

Healthcare models are obliged to introduce reforms to counter disparities in the quality of care given and rising costs. To achieve sustainable and better quality healthcare models, administrations worldwide are introducing population health management initiatives. This initiative focuses on the health needs of a particular population in terms of health and wellbeing. One of the main aims is to address the need to prevent or postpone chronic diseases and shift from fee-for-service to value-based care.

Evaluating the three scopes of Triple Aim remains challenging because costs, the models of population health, and the value of health care provided is not uniformly well-defined, and their measurement mechanisms continue to be developed. Complicating the situation are the new trends concerning concepts in health and quality of care and the advent of new measurement mechanisms (Roy et al., 2017). The available frameworks have various possible measures that provide a measurement burden and lack comparability.

Trends in Healthcare Delivery Models

Healthcare delivery and financing systems have been transforming as they shift from a fee-for-service model to integrated accountable care and a value-based approach. The challenge is finding the most appropriate way to support health systems to adopt patient-centered care, reduce costs, and improve population health. Accountable care seeks to transform health care models into patient-centered systems that promote coordination, access, wellbeing, and prevention in a risk-based cost system. Components of accountable care include:

• Providing support for high-risk patients.
• Facilitating and ensuring access.
• Coordinating care across the care continuum.
• Having shared accountability and decision-making process between caregivers and their patients.

These components are to be supported by promoting prevention and wellbeing and measuring and monitoring processes and outcomes.

According to the HealthyPeople website (2020), the last decade saw twenty million adults gain health insurance coverage due to the Affordable Care and the Patient Protection Act. Despite reducing the figure of uninsured, millions of citizens still do not have coverage. Significant disparities in age, sex, level of education, race, and income still exist. Market trends have become dynamic as consumerism and transparency have continued to impact healthcare delivery for the past few years. Despite initiatives like the Triple Aim approach, growing healthcare costs show no signs of reducing. Consumers are becoming more proactive in calling for transparent systems and choices in their healthcare experience.

On a positive note, healthcare providers have made significant progress in implementing accountable care payment systems. Providers to adopt or seriously consider more financial risk as a strategy to achieve accountable care objectives. In terms of costs, Vogenberg & Santilli (2019) indicate that out-of-pocket (OOP) expenditures rose by 14% between 2017 and 2018. Other patient costs, such as patient deductible and copays, outpatient OOP, and the average OOP bill, increased over the same period. The rise in these costs is attributed to healthcare providers placing increased importance on the value of their communication strategies, employers focusing on providing benefits for their workforce, and manufacturers’ increased investment in stakeholders and creating value-based scientific and marketing resources (Vogenberg & Santilli, 2019). Consumers are thus paying higher insurance premiums due to the increase in healthcare costs.

Quality and Safety Impact on Delivery Models in Health Care

Safety in healthcare has received significant focus in the past two decades as the healthcare system endeavor to provide coherent programs to improve safety. Safety programs seek to change culture, processes, and process measurement. The creation of safety standards has impacted healthcare delivery models by setting great levels of performance expected from healthcare workers. Since the release of the ‘To Err is Human report in 1999, stakeholders have contended that safety concerns are a dominant feature across healthcare delivery points, and consumers are often injured while under care (Bates & Singh, 2018). Hospitals across the board have consequently adopted robust scrutiny for the major forms of hospital-acquired infections. Providers continue to adopt effective measures to combat medication errors. This includes computerizing the ordering of medicine to reduce adverse drug events. Safety improvement is being implemented through effective safety culture and good management (Bates & Singh, 2018). Major national policies have been developed to address safety, like the Patient Safety and Quality Improvement Act, and the Centers for Medicare & Medicaid Services (CMS) and the Partnership for Patients are advancing resources to lower preventable injury.

The focus on quality impacts delivery models to produce value-based healthcare systems that provide preventative care that reduces cost. Healthcare practitioners emphasize treatment methods that enable patients to recover quickly and effectively. Healthcare delivery models focus more on improved care coordination and increased patient satisfaction. The models have also focused on more robust cost control and reduced financial risk for consumers. Value-based care is aimed at benefitting patients, payers, and healthcare providers (Vogenberg & Santilli, 2019). Lowering costs results in insurance companies paying less and patients paying lower deductibles and premiums.

Conclusion

As the healthcare ecosystem continues to transform, providers are increasingly implementing accountable and value-based healthcare delivery models. The shift to value-based care from fee-for-service models continues amidst various challenges. Issues that need to continue to be addressed include increasing insurance coverage, addressing population disparities, and determining changes in the healthcare workforce (HealthyPeople, 2020). Federal and state governments and healthcare providers continue to embrace accountable care to bolster the quality of health care and the health of the population and reduce costs.

References

Bates, D. & Singh, H. (2018). Two decades since To Err Is Human: An assessment of progress and emerging priorities in patient safety. Health Affairs. Web.

IHI. (2020). ​​Triple Aim for populations. Institute for Healthcare Improvement. Web.

HealthyPeople. (2020). Access to health services. Web.

Obucina, M., Harris, N., Fitzgerald, J., Chai, A., Radford, K., Ross, A., Carr, L. & Vecchio, N. (2018). The application of triple aim framework in the context of primary healthcare: A systematic literature review. Health Policy, 122 (8), 900-907. Web.

Roy, J., Hendrikx., H. Drewes., M., Dirk, R., Jeroen, N. & Struijs, C. (2017). Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis. Health Policy, 120 (5), 471-485. Web.

Vogenberg, F., & Santilli, J. (2019). Key trends in healthcare for 2020 and beyond. American Health & Drug Benefits, 12 (7), 348–350. Web.