Delivery Models in Health Care
Write a 1,250-1,500-word essay about delivery models in health care. Include the following in your essay:
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The goal of health care reform is to widen the population that obtains health care coverage, improve care quality, improve access to health care programs and specialists and minimize health care costs. The Triple Aim framework has three connected goals of improving the health of the population, improving an individual’s experience of care, and minimizing per capita care costs. The paper addresses the Triple Aim as it relates to population health management and delivery models and how quality and safety impact delivery models in health care.
The Triple Aim as it relates to population health management and delivery models
The Triple Aim is a healthcare quality improvement framework set forth by the Institute for Healthcare Improvement (IHI) in 2007. Aacvpr (2020) indicates that according to the framework, there should be the development of new designs to concurrently pursue the three dimensions of the best possible care: improving population health, improving care quality, and lowing care cost. The Triple Aim framework is, in context, functional in a population health management model. Population health management is defined as incorporated health care for patients within a health system. It applies interventions and strategies across the care continuum to improve health care outcomes and experience at competitive costs.Delivery Models in Health Care
The Institute for Healthcare Improvement (IHI) set forth the Triple Aim to provide an agenda for the optimization of performance on three care dimensions: the health of a distinct population, the individual’s experience of care in the population, and the cost per capita for provision of care for this population. Population refers to the inclusion or enrollment in a registry. Groups of persons that are defined by condition, geography, or other characteristics can be regarded as a population if there is the availability of data to track them over a certain (Nash et al., 2019).
Efforts for value optimization are at the center of this initiative. Numerous integrators in the United States are working to implement plans to attain the Triple Aim. According to Nash et al. (2019), integrators at the macro level are pooling resources and making sure that the system processes and structure are supporting the needs of the population. Integrators at the micro-level are ensuring that the most suitable care is offered to patients in regard to misuse, underuse, or overuse. For the achievement of the Triple Aim, healthcare delivery systems and institutions must minimize hospitalizations, allocate resources to care for the patient that is matching to their needs and create continued relationships that are heedful to the needs of patients. Whereas more work is needed to attain the best possible performance on the three objectives, the Triple Aim has created awareness and provides a framework for the management of population health.
Current trends in health care delivery models
Consumerism along with transparency in healthcare has been trending for the past few years. Healthcare consumers have realized that they must take active roles in ensuring that they get the best value for the money they spend on healthcare. Patients becoming more and more proactive in demanding transparency as well as choice in their experience of health care. The success of healthcare providers will be dependent on their capability to meet the expectations and needs of consumers. Providers will be required to manage the supply chain of healthcare to provide patients with cost-efficient, access and best-quality choices (Vogenberg & Santili, 2019).Delivery Models in Health Care
Numerous marketplace dynamics are drivers of the increased transparency and consumerism at both the federal and state levels, including high out of pocket costs and downside risk arrangements. Regarding downside risk arrangements, providers go on making progress in implementing value-based models of payment. Vogenberg and Santili (2019) assert that this accomplishment with programs that provide incentives to providers for offering quality care has made providers pay more focus on using financial risk as a strategy to be successful in the coming three to five years. Healthcare providers will have a daily financial obligation for their patient population, with heightened downside risk arrangements.
When choosing to take on greater risk management, healthcare providers will be required to expand telehealth and home services in midst of a c persistent decline in rural hospitals. Providers will be required to put into consideration the significance of social determinants of health and augmented transparency when creating programs for managing the sickest consumers. Site of care treatment is increasingly becoming a more significant factor in the strategy of a provider (Vogenberg & Santili, 2019).
The continued rise in the costs of healthcare has led to insured patients paying more for health care services in out of pocket costs and premiums. The increasing total const to customers is leading to a demand for increased transparency and insight into costs of healthcare. This demand has to lead to additional information essential for customer comparison shopping and the CMS has made it mandatory for hospitals and other healthcare institutions to post their charges online, with health plans utilizing customer experience along with outcomes measures reported by patients (Vogenberg & Santili, 2019).
In a bid to control the growing healthcare costs, the healthcare industry is moving toward wellness as a portion of the value-based care system. According to Salmond and Echevarria (2017), moving toward wellness requires a move away from a care system whose focus is on illness to a care system that gives priority to prevention and wellness. This implies preventive and wellness-focused programs, health education, and wellness programs along with programs to address social or environmental triggers of care problems of preventable medical conditions must take an equal significance of focus as the clinical intervention that is focused on care that providers deliver. At individual practitioner and organizational levels, wellness implies think about the consumer beyond the present event (hospital or office) and taking into consideration what must be done or assessed to maximize the wellness of a person.Delivery Models in Health Care
The utilization of technology and virtual care will permit a continual focus on population health, particularly for the states struggling to balance the provision of care in rural and urban areas. Vogenberg and Santili (2019) indicate that States also need to strike a balance between the economics of delivery of healthcare with the state financial duties (for example, Medicaid, pensions), and the politics of operating a state government. Harnessing technology to aid in healthcare costs management is still a standard strategy for states as payers and purchasers of health care.
How quality and safety impact delivery models in health care
Reforms in payment in health care are influencing delivery models in health care, with a change in payment focused on safety, efficiency, and quality care outcomes. According to Francavilla (2019), the topmost goal is to deliver that are cost defective and demonstrate preferred outcomes. Thus, value-based models of payment offer incentives to regulate costs as well as improve care quality. Providers are required to utilize evidence-based interventions that focus on disease management and prevention to manage different patient groups. Also, providers are required to utilize well care and prevention that focus on screening and lessening the incidence of an illness. Early detection provides a chance to slow the progression of some diseases and these interventions are directed by social determinants of health and family history.
A shift from fee-for-service care to value-based care is a pathway to attaining the objectives of the IHI’s Triple Aim. According to Teisberg et al. (2020), in health care, value refers to the measured improvement in the health outcomes of a patient for the cost of attaining this improvement. Value-based care reform is aimed at enabling health care systems to generate more value for consumers. Population health can only be improved when the health outcomes of several persons are improved, and value-based care focuses on this. Cost also accrues from the health care services provided for individuals. Through the organization of teams of health care professionals to deliver care to individuals who have similar care needs, a value-based model enhances efficiency and expertise, instead of rationing care in order to reduce costs. This places decision making on the way to deliver care on the team of clinicians instead of an insurance administrator, enhancing clinicians’ professionalism and the power of relationships between the patient and the clinician to deliver appropriate and effective care.
The Triple Aim is a healthcare improvement framework developed by the IHI with the purpose to help health care systems to optimize performance, improve patient care and reduce costs through a range of metrics and interventions. The framework requires the development of new designs to concurrently pursue the three dimensions of optimal care which include improving population health, lowering care costs, and improving care quality. The concurrent pursuit of all goals is needed to attain the Triple Aim. A shift from fee-for-service to value-based care is a path to attaining the goals of the Triple Aim.Delivery Models in Health Care
American Association of Cardiovascular & Pulmonary Rehabilitation, Aacvpr. (2020). Guidelines for Cardiac Rehabilitation Programs. Human Kinetics.
Francavilla, C. (2019). Understanding the Impact of Care Delivery Models in Value-Based Payment. MedSurg Nursing, 28(5), 331-338.
Nash, D. B., Skoufalos, A., Fabius, R. J., Clarke, J. L., & Howowitz, M. R. (2019). Population Health: Creating a Culture of Wellness. Jones & Bartlett Publishers.
Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic Nursing, 36(1), 12-25. doi: 10.1097/NOR.0000000000000308
Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and Implementing Value-Based Health Care: A Strategic Framework. Academic Medicine, 95(5), 682-685. doi: 10.1097/ACM.0000000000003122
Vogenberg, F. R., & Santili, J. (2019). Key Trends in Healthcare for 2020 and Beyond. American Health and Drug Benefits, 12(7), 348-350.Delivery Models in Health Care