US Healthcare System and Quality Improvement

What does it mean to go from a volume-based to value-based healthcare environment?

Transitioning from a volume-based to a value-based health care environment is a change that is expected to occur in the close future in the U.S. health care system (Bristol & Joshi, 2014). Nowadays, the U.S. health care system offers volume-based care, which means that health care providers are reimbursed for their services rather than the quality of the latter, and high quality remains unrewarded; providers do not share financial risks with clients; hospitals focus on acute inpatient care; IT investments are not incentivized; stand-alone health care organizations often flourish; and regulations may serve as barriers to hospital-medic collaboration (Bristol & Joshi, 2014, p. 542).

On the contrary, transitioning to a value-based health care environment would mean that payment for medical services would depend on the quality of care, rewarding higher quality; patients and hospitals would share risks; patients with severe conditions would become the focus; IT would be essential in medical care; large-scale care systems would become more important; and coordination between medics and hospitals would be incentivized (Bristol & Joshi, 2014, p. 542).

Discuss the emerging quality of care issues

Numerous problems pertaining to the quality of care emerge today (Boykin, Schoenhofer, & Valentine, 2014). For instance, there is the problem of lowering the readmission rate and enhancing the care continuum (Barnett, Hsu, & McWilliams, 2015). Nearly 20% of Medicare patients experience readmission within 30 days of discharge, and approximately 90% of these readmissions are unplanned, which means that considerable improvements are required (Bristol & Joshi, 2014, pp. 543-545).

Also, it is paramount to transition to population health care; nowadays, the medical system is aimed at managing health outcomes for individual patients, whereas it is needed to turn attention on defined groups of people, taking a proactive approach (Bristol & Joshi, 2014). In addition, it is pivotal to spread improvement: whereas new, effective methods of care and management are created rather often, their implementation in health care facilities often lags (Bristol & Joshi, 2014). It is also essential to introduce innovations such as patient-centered medical homes (PCMHs) or accountable care organizations (ACOs), which could become instrumental in enhancing the quality of the health care system (Bristol & Joshi, 2014).

Discuss mechanisms to improve population health

On the whole, increasing the health of the population depends upon the interaction between three main mechanisms, namely, a) enhancing the utilization of evidence-based preventive medicine and preventive behavioral patterns, b) advancing the quality of care and the safety of medical service consumers, and c) improving the coordination of the provision of care across the whole continuum of care (Bristol & Joshi, 2014). The implementation of these mechanisms may be an effective instrument of enhancing the levels of health of the population, and it is stated that certain health care facilities are already realizing some initiatives for their use; however, systematic changes are needed so as to put these mechanisms to act on a larger scale (Bristol & Joshi, 2014).

Discuss factors affecting the spread of improvements

The spread of improvements is affected by four main factors. These include (Bristol & Joshi, 2014):

  • external environmental factors, such as legal issues, monetary payback, the perceptions in the society, etc.;
  • initiative characteristics, for example, the easiness of understanding the initiatives by main stakeholders, or the strength of arguments and evidence in favor of the effort;
  • the target audience for adoption, that is, the number of people required to accept the change and implement it, and the manner in which the change will impact those affected by it;
  • internal organizational factors, for instance, the resources needed the alignment with the culture of an organization, the availability of high-quality leadership, etc. (Bristol & Joshi, 2014).

On the whole, making appropriate use of resources that may affect the factors impacting the spread of improvements could prove instrumental in promoting enhancements in the health care system (Boykin et al., 2014).

References

Barnett, M. L., Hsu, J., & McWilliams, J. M. (2015). Patient characteristics and differences in hospital readmission rates. JAMA Internal Medicine, 175(11), 1803-1812. Web.

Boykin, A., Schoenhofer, S., & Valentine, K. (2014). Health care system transformation for nursing and health care leaders: Implementing a culture of caring. New York, NY: Springer.

Bristol, S., & Joshi, M. S. (2014). Chapter 21: Transforming the healthcare system for improved quality. In M. S. Joshi et al. (Eds.), The healthcare quality book: Vision, strategy, and tools (3rd ed.; pp. 541-559). Chicago, IL: Health Administration Press.