Delivery Care Models

Introduction

The goal of health care reform is to broaden the population that obtains health care reporting, improve care quality, improve access to wellness care programs and specialists and minimize health care prices. The triple objective framework has three related objectives: to improve the health of the population, to improve the care experience of an individual, and to minimize per capita care costs. The paper focuses on the threefold goal of population health management and delivery models and the impact of quality and safety on healthcare delivery models.

The Triple Aim as it relates to population health management and delivery models

The Triple Goal is a framework for improving the quality of healthcare introduced by the Institute for Healthcare Improvement (IHI) in 2007. Fitzpatrick et al., (2019) argue that according to the framework, there should be the maturation of new designs to concurrently pursue the three dimensions of the best possible care: improving population health, improving care quality, and lowering maintenance cost. The Triple Goal framework is, in its context, functional under a population health management model. Population health management is defined as comprehensive health care for patients in a health system. It applies interventions and strategies throughout the continuum of care to improve healthcare outcomes and experience at competitive costs.

The Institute for Healthcare Improvement (IHI) set forth the Triple Aim to offer a program for the optimization of execution along three core dimensions: the health of a distinct population, the individual’s experience of tending to the population, and the cost per capita for provision of maintenance for this population. Population means inclusion or registration on a register.

Value optimization efforts are a central focus of this initiative. Many integrators in the U.S. are working to implement plans to meet the triple goal. According to Al-Ramahi & Noteboom (2018), macro-level integrators pool resources and make sure the system’s processes and structure meet the needs of the population. Micro-level integrators ensure that the most appropriate care is provided to patients in terms of abuse, underutilization, or overexploitation. For the accomplishment of the Triple Aim, healthcare delivery systems and institutions must minimize hospitalizations, allocate resources to worry for the patient that is equal to their demands and create continued relationships that are attentive to the demands of patients. While more work is required to achieve the best possible performance on all three objectives, the Triple Aim has created a consciousness. It offers a theoretical account for managing population health.

Current trends in healthcare delivery models

Consumerism and transparency in healthcare have been fashionable in recent years. Healthcare consumers have recognized that they must assume active parts in seeing to it that they receive the best value for their healthcare money. Patients are increasingly proactive in seeking transparency and choice in health care. The success of healthcare providers will depend on how well they meet the expectations and needs of consumers. Providers will have to manage the healthcare supply chain to provide patients with cost-effective access and higher-quality choices.

 Many market dynamics are engines of increased transparency and consumerism both federally and at the state level, including high direct costs and downside risk arrangements. With respect to downside risk arrangements, suppliers continue to make progress toward implementing value-based payment models. Lopez et al., (2020) assert that this accomplishment with programs that offer incentives to providers for offering quality care has made providers focus on using financial risk as a strategy to win in the coming three to five years. Healthcare providers will be financially obligated on a daily basis for their patient population, with increased downside risk arrangements.

When choosing to improve risk management, healthcare providers will need to expand telehealth and home care services during a continuing decline in rural hospitals. Providers will have to consider the importance of the social determinants of health and greater transparency when developing programs to manage the sickest consumers. On-site therapy is becoming an increasingly important factor in a caregiver’s strategy.

The ongoing increase in health care costs has resulted in insured patients paying higher fees and premiums for health care services. The increase in total cost to clients leads to a demand for increased transparency and greater knowledge of healthcare costs. This resulted in additional information that was essential to compare clients. The CMS has made it mandatory for hospitals and other healthcare facilities to post their fees online, health plans that use the customer experience, and measures of patient outcomes.

The healthcare industry is shifting to wellness as an integral part of the value-based healthcare system to control rising healthcare costs. According to Lopez et al., (2020), moving toward health requires moving away from a care system that focuses on illness to a care system that prioritizes prevention and wellness. This implies preventive and wellness-centered programs, health training, and wellness programs to direct social or environmental triggers of care problems of preventable medical conditions must contain an equal significance of focus as the clinical intervention focused on care providers deliver. At individual practitioner and organizational levels, wellness implies thinking about the consumer beyond the current event (hospital or agency) and seeing what must be done or assessed to maximize a person’s health.

 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. Reed et al., (2019) indicate that States also need to strike a balance between the economics of healthcare delivery 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 healthcare.

How quality and safety impact delivery models in healthcare

Reforms in payment in health care influence delivery models in health care, with a price change, focused on safety, efficiency, and quality care outcomes. According to Rosen et al., (2018), the top goal is to deliver that are cost defective and demonstrate preferred results. Thus, value-based models of payment offer incentives to regulate costs and improve care quality. Providers must utilize evidence-based interventions that focus on disease management and prevention to manage different patient groups. Also, providers must use 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 IHI’s Triple Aim objectives. According to Fitzpatrick et al., (2019), in health care, value refers to the measured improvement in a patient’s health outcomes for the cost of attaining this improvement. Value-based care reform aims to enable healthcare 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. By organizing teams of healthcare professionals to deliver care to individuals who have similar care needs, a value-based model enhances efficiency and expertise instead of rationing care to reduce costs. This places decision-making on providing care on the team of clinicians instead of an insurance administrator, improving clinicians’ professionalism and the power of relationships between the patient and the clinician to deliver appropriate and effective care.

Conclusion

The Triple Aim is a healthcare improvement framework developed by the IHI to help healthcare systems 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 achieving the Triple Aim goals. Delivery Models in Health Care.

References

Al-Ramahi, M., & Noteboom, C. (2018). A Systematic Analysis of Patient Portals Adoption, Acceptance and Usage: The Trajectory for Triple Aim?.

Fitzpatrick, B., Bloore, K., & Blake, N. (2019). Joy in work and reducing nurse burnout: from triple aim to quadruple aim. AACN advanced critical care, 30(2), 185-188.

Lopez, C. D., Boddapati, V., Lombardi, J. M., Lee, N. J., Saifi, C., Dyrszka, M. D., … & Lehman, R. A. (2020). Recent trends in medicare utilization and reimbursement for lumbar spine fusion and discectomy procedures. The Spine Journal, 20(10), 1586-1594.

Reed, N. S., Altan, A., Deal, J. A., Yeh, C., Kravetz, A. D., Wallhagen, M., & Lin, F. R. (2019). Trends in health care costs and utilization associated with untreated hearing loss over 10 years. JAMA Otolaryngology–Head & Neck Surgery, 145(1), 27-34.

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433.