Day 4: Healthcare delivery models and their impact on operations

Welcome students to the lesson on healthcare delivery models. Today we will be discussing what healthcare delivery models are, why they are important, and how they impact the quality and cost of care.

Healthcare delivery models refer to the different approaches used by healthcare organizations to deliver care to patients. These models can impact the quality of care provided, the cost of care, and the patient experience. For example, some healthcare providers use the traditional fee-for-service model, while others use value-based care or patient-centered medical homes.

It is important to understand healthcare delivery models because they can impact the quality of care you receive and the cost of care. Depending on the model used, you may receive different types of care, such as preventative care, and may have different levels of coordination between healthcare providers.

Have any of you ever visited a healthcare provider that used a different delivery model than traditional fee-for-service? How did your experience differ?

Today we will explore the different types of healthcare delivery models and their characteristics, as well as discuss the advantages and disadvantages of each model. Let’s get started.

Healthcare delivery models refer to the different approaches used by healthcare organizations to deliver care to patients. The delivery model used by a healthcare organization can impact the quality of care provided, the cost of care, and the patient experience. There are several different types of healthcare delivery models, including:

Traditional fee-for-service model: In this model, healthcare providers are paid for each service provided, regardless of the outcome or quality of care. This model has been criticized for incentivizing overutilization of services and driving up healthcare costs.
Value-based care model: This model focuses on providing high-quality care that leads to positive health outcomes for patients, while also controlling costs. Providers are paid based on the value of the care they provide, rather than the volume of services.
Patient-centered medical home model: This model emphasizes primary care and coordinated care between healthcare providers. It is designed to improve patient outcomes and reduce costs by providing a comprehensive and integrated approach to care.
Accountable care organization model: This model involves a network of healthcare providers working together to coordinate care and improve quality while reducing costs. Providers are held accountable for the health outcomes of their patients.

Examples of healthcare organizations that use each type of delivery model include:

Traditional fee-for-service model: Some private practices and hospitals still use this model, although it is becoming less common.
Value-based care model: Medicare and some private insurers use value-based payment models. Health systems like Kaiser Permanente also use this model.
Patient-centered medical home model: The Veterans Health Administration and some private practices use this model.
Accountable care organization model: Medicare and some private insurers have established ACOs, as have health systems like Intermountain Healthcare and Partners Healthcare.

Overall, the choice of healthcare delivery model can have significant impacts on healthcare operations and patient outcomes. Healthcare organizations must carefully consider the advantages and disadvantages of each model when designing their care delivery systems.

Traditional fee-for-service model

The traditional fee-for-service model is a healthcare delivery model in which healthcare providers are reimbursed for each service they provide, regardless of the outcome or quality of care. Under this model, patients typically pay a portion of the cost of care, and insurance companies cover the rest.

In the fee-for-service model, healthcare providers are incentivized to provide more services, as each service performed represents a source of revenue. This can result in overutilization of services, which can drive up healthcare costs and may not necessarily improve patient outcomes.

One advantage of the fee-for-service model is that it allows patients to choose their own providers and the services they receive. Providers are also compensated for the work they do, which can incentivize them to provide high-quality care.

However, the fee-for-service model has several disadvantages. It can lead to fragmentation of care, as providers may not communicate effectively with each other or coordinate care across different specialties. Additionally, the model can create financial incentives for providers to order unnecessary tests or procedures, which can drive up costs and may not improve patient outcomes.

The financial impact of the fee-for-service model on healthcare operations can be significant. Providers must constantly attract new patients to generate revenue, which can lead to competition and increased marketing costs. Additionally, providers must manage billing and collection processes to ensure they are reimbursed for the services they provide. These administrative tasks can be time-consuming and costly.

Overall, while the fee-for-service model has some advantages, its overreliance on service volume and fragmentation of care have led to efforts to shift towards alternative models, such as value-based care and patient-centered medical homes, that prioritize quality over quantity and promote coordinated care.

Value-based care model

Patient-centered medical home model

The patient-centered medical home (PCMH) model is a healthcare delivery model that emphasizes primary care and coordinated care between healthcare providers. The model is designed to improve patient outcomes and reduce costs by providing a comprehensive and integrated approach to care.

In the PCMH model, a primary care provider serves as the patient’s “medical home,” coordinating all aspects of the patient’s care and ensuring that the patient receives appropriate care from specialists and other providers as needed. The model also places a strong emphasis on preventative care and patient engagement.

One advantage of the PCMH model is that it can lead to better care coordination and communication between providers, which can improve patient outcomes and reduce costs. Additionally, the model promotes a focus on preventative care and patient education, which can lead to better health outcomes over the long-term.

However, the PCMH model has some disadvantages. It can be difficult to implement in certain healthcare systems, particularly those that are fragmented or lack resources. Additionally, the model requires a significant investment in technology and infrastructure to support data sharing and care coordination.

The impact of the PCMH model on healthcare operations can be significant. Providers must focus on primary care and coordinated care, rather than simply providing services. This can require a shift in organizational culture and the development of new processes and protocols for communication and collaboration between providers.

Overall, the PCMH model promotes a patient-centered approach to care that prioritizes primary care and coordinated care. While it has some challenges, it has the potential to improve patient outcomes and reduce costs over the long-term.

Accountable care organization model

The accountable care organization (ACO) model is a healthcare delivery model that involves a network of healthcare providers working together to coordinate care and improve quality while reducing costs. The model is designed to improve patient outcomes by promoting a team-based approach to care delivery.

In the ACO model, healthcare providers work together to coordinate care for a defined patient population. Providers are held accountable for the quality and cost of care for their patients, and are incentivized to improve outcomes while reducing costs.

One advantage of the ACO model is that it promotes a team-based approach to care delivery, which can lead to better care coordination and improved patient outcomes. Additionally, the model provides financial incentives for providers to reduce costs and improve quality, which can help to reduce healthcare costs over the long-term.

However, the ACO model has some disadvantages. It can be difficult to implement in certain healthcare systems, particularly those that are fragmented or lack resources. Additionally, the model requires a significant investment in technology and infrastructure to support data sharing and care coordination.

The impact of the ACO model on healthcare operations can be significant. Providers must focus on quality improvement and cost reduction, rather than simply providing services. This can require a shift in organizational culture and the development of new processes and protocols for communication and collaboration between providers.

Overall, the ACO model promotes a team-based approach to care delivery that prioritizes quality improvement and cost reduction. While it has some challenges, it has the potential to improve patient outcomes and reduce costs over the long-term.

The choice of healthcare delivery model can have a significant impact on healthcare operations, including staffing, technology, and patient satisfaction.

Staffing: Different delivery models may require different staffing models. For example, the PCMH model requires a team-based approach to care delivery, which may require additional staff such as care coordinators or patient educators. In contrast, the fee-for-service model may prioritize provider productivity and efficiency.
Technology: Healthcare organizations may need to invest in new technologies to support new delivery models. For example, the ACO model requires robust data sharing and care coordination technologies to be effective.
Patient satisfaction: Different delivery models may impact patient satisfaction in different ways. For example, the PCMH model may lead to higher patient satisfaction due to the emphasis on coordinated care and patient engagement.

Implementing new delivery models can present both challenges and opportunities. Some challenges may include resistance to change from providers and staff, the need for additional resources and training, and potential financial risks associated with new models. However, successful implementation of new delivery models can lead to improved patient outcomes, reduced costs, and enhanced patient satisfaction.

Examples of healthcare organizations that have successfully implemented new delivery models include:

Intermountain Healthcare, which has implemented an ACO model and seen improvements in patient outcomes and reduced costs
Kaiser Permanente, which has implemented a value-based care model and has consistently been ranked highly for patient satisfaction
Geisinger Health System, which has implemented a PCMH model and has seen improvements in patient outcomes and reduced costs

Overall, healthcare organizations must carefully consider the advantages and disadvantages of different delivery models when designing their care delivery systems. By investing in new delivery models and promoting a patient-centered approach to care, healthcare organizations can improve patient outcomes, reduce costs, and enhance the overall healthcare experience.

Conclusion:

The key takeaways from this lesson are that healthcare delivery models play a crucial role in improving patient outcomes, reducing costs, and enhancing the overall healthcare experience. By selecting the appropriate delivery model for their organization, healthcare providers can improve care coordination, promote preventative care, and prioritize quality over quantity. It is important for healthcare organizations to analyze how different delivery models impact healthcare operations, including staffing, technology, and patient satisfaction, and to develop effective strategies for implementing new delivery models.

Students should apply the concepts learned in this lesson to their own healthcare organizations or communities by thinking about how different healthcare delivery models could be used to improve healthcare. By taking a patient-centered approach to care and promoting a team-based approach to care delivery, healthcare providers can improve patient outcomes, reduce costs, and enhance the overall healthcare experience for their patients.