Background For Both Discussion Post and Assignment

Paying providers based on the quality of care rather than the quantity of care is a revolutionary concept. But the health care industry is bending inexorably toward this goal. Evidence-based medicine (EBM) and the ability to track patient outcomes is the core support of the transition from the older model of volume-based health care pricing to that of value-based delivery. Patient outcomes, especially for patients with chronic conditions, can be improved drastically when outcomes for the full cycle of care are tracked and costs lowered.

This week, you will evaluate the impact of the change from volume- to value-based health care delivery in two organizations in order to suggest beneficial changes in operations.

Learning Objectives

Students will:
- Evaluate organizational responses to the transition from a volume- to a value-based health care delivery system
- Compare and contrast responses to the change in health care delivery systems in different organizations
- Analyze operational changes resulting from the impact of transition from a volume- to a value-based health care delivery system

Assignment topic: Adjustments to Transitions in Health Care Delivery

Consider what you've learned so far about the transition from volume- to value-based reimbursement. Different organizations will respond to the impact of this change in various ways. Based on its actions, an organization may flourish, or it may fail as its reimbursement decreases. As reimbursement methodology changes, institutions must adapt.

To prepare for this Assignment:
Read Case 5: Middleboro Community Hospital in this week's Learning Resources, and consider the actions taken by this organization. Review data tables regarding their case mix (top DRGs), Patient Days, and CMS Core Measures. These metrics address both qualitative and quantitative measures in this organization.

The Assignment:
Write a brief, 2-page executive summary of the impact of the transition from volume-based to value-based health care. Specifically, address how this change in reimbursement methodology impacts operational requirements and how it can be implemented. Recommend at least two adjustments to operations which may position the organization for success under value-based health care.Discussion Post and Assignment

Paying providers based on the quality of care rather than the quantity of care is a revolutionary concept. But the health care industry is bending inexorably toward this goal. Evidence-based medicine (EBM) and the ability to track patient outcomes is the core support of the transition from the older model of volume-based health care pricing to that of value-based delivery. Patient outcomes, especially for patients with chronic conditions, can be improved drastically when outcomes for the full cycle of care are tracked and costs lowered.
This week, you will evaluate the impact of the change from volume- to value-based health care delivery in two organizations in order to suggest beneficial changes in operations.

Learning Objectives
Students will:
- Evaluate organizational responses to the transition from a volume- to a value-based health care delivery system
- Compare and contrast responses to the change in health care delivery systems in different organizations
- Analyze operational changes resulting from the impact of transition from a volume- to a value-based health care delivery system

Discussion Post Topic: Transitions in Health Care Delivery
At the core of the value transformation is changing the way clinicians are organized to deliver care. The first principle in structuring any organization or business is to organize around the customer and the need. In health care, that requires a shift from today's siloed organization by specialty department and discrete service to organizing around the patient's medical condition. We call such a structure an integrated practice unit (IPU). In an IPU, a dedicated team made up of both clinical and nonclinical personnel provides the full care cycle for the patient's condition.
-Michael Porter and Thomas Lee
The impact on value of IPUs is striking. With a dramatic contrast compared to regional averages, patients at Virginia Mason's Spine Clinic miss fewer days of work (4.3 versus 9 per episode) and need fewer physical therapy visits (4.4 versus 8.8).
The shift to value-based health care delivery represents an opportunity to create a more patient-centered organization as well as a more efficient one. Resource limitations and other pressures place a strain on an organization's ability to change, and organizations respond to these pressures of change differently.

To prepare for this Discussion:
Consider the impact of the transition from volume- to value-based health care delivery in your organization or one with which you are familiar.
Potential transitions to consider may be examples such as the shift from inpatient to ambulatory care, the Patient Centered Medical Home (PCMH) initiative, or the Delivery System Reform Incentive Payment (DSRIP) initiative.

With this in mind, read the Porter and Lee article published in the Harvard Business Review, and compare their strategic proposal with the transition you are considering.

Post a cohesive response to the following:
Describe the nature of the transition in the organization. Discuss and assess how this transition affected operations, based on the organization's operational resources and limitations. How did the organization respond to the changes? Was the response effective? How does the IPU approach compare to the transition response? Justify your conclusion. Recommend an alternative course of action.
Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.
Read a selection of your colleagues' postings. Consider how your colleagues' postings relate to the information presented in the Learning Resources and to your own posting.