Monday, July 20, 2009

Incenting the Ideal Health Care Delivery System

Several key themes emerge from 15 Case Studies of high performing health systems.


The Commonwealth Fund recently published a very interesting report on how to reform the health care delivery system by sharing a series of case studies of high performing health systems. I recently highlighted some of the work of Group Health, but wanted to pull out some of the more generic information about the principles of reform that have been learned from these case studies. These principles were first elucidated in the Commonwealth's "Organizing the US Healthcare Delivery System for High Performance" issues in August 2008.


Six Attributes of an Ideal Health Care Delivery System
  1. Information Continuity. Patients’ clinically relevant information is available to all providers at the point of care and to patients through electronic health record (EHR) systems.
  2. Care Coordination and Transitions. Patient care is coordinated among multiple providers, and transitions across care settings are actively managed.
  3. System Accountability. There is clear accountability for the total care of patients. (We have grouped this attribute with care coordination, since one supports the other.)
  4. Peer Review and Teamwork for High-Value Care. Providers (including nurses and other members of care teams) both within and across settings have accountability to each other, review each other’s work, and collaborate to reliably deliver high-quality, high-value care.
  5. Continuous Innovation. The system is continuously innovating and learning in order to improve the quality, value, and patients’ experiences of health care delivery.
  6. Easy Access to Appropriate Care. Patients have easy access to appropriate care and information at all hours, there are multiple points of entry to the system, and providers are culturally competent and responsive to patients’ needs.

You will notice that many of these principles can be found in the incentive and measurement structure of the Healthcare X PRIZE. We are trying to motivate teams to provide the type of care that has been shown over and over to delivery the best care. However, we are not asking people to replicate Kaiser, Intermountain, Mayo, or Geisinger - we are asking them to improve upon those models. While they deliver the best care today, we believe there exists even better, more efficient, and more effective care models out there. We look forward to the many teams, conveners, stakeholders, and other parties coming to the table to surprise us with their novel concepts, ideas, and incentive structures.

Can't wait to see what the innovation approach from a field of what we anticipate will be a global competition.
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