7-1 Discussion Models of Service Delivery
Write a 1,250-1,500-word essay about delivery models in health care. Include the following in your essay:
Address the triple aim as it relates to population health management and delivery models.
Discuss current trends in health care delivery models.
Describe how quality and safety impact delivery models in health care.
Include at least three peer-reviewed/academic references in your essay, including the Healthy People website.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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Delivery Models Essay
The Triple Aim
The Institute for Healthcare Improvement developed the triple aim, which is a framework that provides the approach that health systems should use to enhance their performance. The IHI recommends that there should be new designs in healthcare systems which fulfil three major targets which include enhancing and improving patient experience in care, enhancing the population health, and reducing the per capita cost of obtaining healthcare services in healthcare settings for the patients (Institute for Healthcare Improvement, 2020). The main reason behind establishing the triple aim was to reduce the costs of healthcare and enhance public health, considering the increasing ageing population that has chronic health problem, and the heavy demands on medical and social services
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The triple aim aligns with the goals of population health management and healthcare delivery models in a number of ways. For instance, in New York, the application of the Triple Aim initiative in healthcare enabled healthcare organizations to redesign their ambulatory care and services, such that they reduced the visit cycle times as well as improved access to the ambulatory care, through its regional health network (Institute for Healthcare Improvement, 2020). The triple aim also helps in improving healthcare delivery models, which evolve to patient-centred care, and using patient education to equip the patients with the knowledge on self-care and management when outside the healthcare setting. For instance, through an initiative referred to as Healthworks within the Genesys Health System in Michigan, practitioners can engage the patients in their own care, which enhances their access to care as well as utilization of the available healthcare resources. This healthcare delivery model has reduced the cost of healthcare for residents by about 10-25%, which achieves the triple aim goal of reduce cost per capita of healthcare (Institute for Healthcare Improvement, 2020).7-1 Discussion Models of Service Delivery
Current Trends in Health Care Delivery Models
A noteworthy trend in healthcare delivery models would be telemedicine, which is the delivery of healthcare services and other related medical services through remote technologies. Telemedicine is a major driver of change in healthcare models given the advent of technology, and enhanced practitioner skills in health technology management (NEJM Catalyst, 2018). Patients in rural areas are among the biggest beneficiaries of telemedicine delivery models because the consultations done with practitioners online and nursing and self-care instructions done remotely save them physical trips to the healthcare facilities. Telemedicine changes the healthcare delivery models because it improves the patient service delivery because of elimination of the concept of patient wait times, and enhances patient-centered care because the patient directly interacts with the physician during their session. The sessions are personalized and specific to patient in telehealth, hence, improving their overall healthcare outcomes.7-1 Discussion Models of Service Delivery
The adoption of telehealth and telemedicine delivery models enhances the triple aim and the achievement of its goals. For instance, by having nursing diagnosis sessions done online, and with nurses providing the care givers with nursing care instructions, and offering patient education, the patient reduces their healthcare costs, which meets the triple aim’s goal of reducing the healthcare costs per capita for the patient. The patient may have been admitted, increasing their hospital charges, which is eliminated if the patient can receive care from home, or remotely through the nurses’ guidance that they provide to the caregivers with the patients at home. Additionally, telehealth enhances population management because it creates an opportunity for healthcare workers to provide patients with sufficient patient education through the online sessions they conduct remotely. Consider a nurse showing a patient how to dress wounds, and how to perform first aid carefully, hence enhancing the self-care skills and techniques, as way to achieve population health management.
Another trend with healthcare delivery models is the Prescription Drug Pricing Reduction Act, which allows customers to negotiate their drug prices. President Trump also issued an executive order in 2019, which calls for increased transparency in pricing of healthcare services provided by healthcare organizations (Whitehouse.gov, 2019). The executive order allows patients to shop around healthcare organizations and providers and making an informed decision based on the full costs of procedures. This trend is critical in healthcare delivery models because it influences the cost models, and prompts healthcare organizations to subsidize their costs, and focus more on patient outcomes, and less on the bottom line. This trend aligns with the triple bottom line by reducing the cost per capita of healthcare for the patients. As mentioned before, the price transparency is bound to increase competition among providers. Therefore, increased competition means reduced cost for the patient, even those under medical covers.
Impact of Quality and Safety on Delivery Models
A significant impact of quality and safety on delivery models manifests in the management of accountable care organizations (ACOs), which have increasingly become a common health delivery model. ACOs are a collaboration of primary healthcare providers such as clinicians and specialists, who accept the responsibility of the quality and the costs of care provided to their patients (Pavarini et al., 2016). Therefore, to successfully run this delivery model, the practitioners must ensure that their patients receive quality and safe services, so as to reduce the costs incurred after incidents such as readmissions. Readmissions sometimes arise from poor quality services, for instance, avoidable patient falls since the hospital has not installed bedside alert systems for the nurses and the patients (Havaei et al., 2019). Readmissions are costly for both the patient and the healthcare organization. Therefore, since the goal of the ACOs is to provide healthcare services for the patients, and the providers shoulder the costs and quality of the care provided, it is imperative that they provide safe and high quality services, to reduce the burden that poor quality services impose on them.
Health homes are another delivery model in healthcare that have become increasingly common especially for the older patients, and those with more complex healthcare needs that require the nurse or physician to attend to them from a home setting. Health homes are a concept that refers to the provision of patients with central primary care practice or providers, who coordinate their care across other providers. To achieve this, health homes capitate payments to the providers so as to enhance preventive care management, and reduce the over-reliance on emergency care. To achieve this, the services provided by the primary care providers must be high quality. To reduce the over-reliance on specialists and emergency care which burdens the patients and the healthcare organizations in terms of cost, the care providers should provide high quality service to the patient. High quality service would entail the patient-centred care. The care should also be provided in a safe environment, to enable the effectiveness of this care delivery model.7-1 Discussion Models of Service Delivery
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Quality and safety also impact care delivery models such as the nurse-managed clinics. These clinics refer to those clinics led by advanced practice nurses who are associated with a school, college, or department of nursing in a school. The quality and safety of the nursing services provided influence the operation of this delivery model. Within the nurse-led clinics, the nurses focus on providing the patients with primary nursing care where they aim to contain costs and optimize patient outcomes. To achieve this, the services should be high quality. For instance, the nurse should ensure to provide the inpatients with a healthy diet, recreational facilities to improve their mental wellbeing, and recruit emotionally intelligent nurses who have the ability to counsel the patients and develop a positive nurse-patient relationship. Such measures enhance the quality of the services provided. Additionally, installing bedside alert systems for when patients leave their beds unassisted would help in increasing patient safety within such a model, especially because it is led by nurses.
References
Havaei, F., MacPhee, M., & Dahinten, V. (2019). The effect of nursing care delivery models on quality and safety outcomes of care: A cross‐sectional survey study of medical‐surgical nurses. Journal Of Advanced Nursing, 75(10), 2144-2155. https://doi.org/10.1111/jan.13997
Institute for Healthcare Improvement. (2020). Achieving the IHI Triple Aim: Summaries of Success | IHI – Institute for Healthcare Improvement. Ihi.org. Retrieved 26 November 2020, from http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/ImprovementStories.aspx.
NEJM Catalyst. (2018). What Is Telehealth?. NEJM Catalyst Innovations In Care Delivery. https://doi.org/10.1056/CAT.18.0268
Pavarini, P., McGinty, C., & Schaff, M. (2016). The ACO Handbook: A Guide to Accountable Care Organizations. American Health Lawyers Association.
Whitehouse.gov. (2019). Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First | The White House. The White House. Retrieved 26 November 2020, from https://www.whitehouse.gov/presidential-actions/executive-order-improving-price-quality-transparency-american-healthcare-put-patients-first/. 7-1 Discussion Models of Service Delivery