Week 6 Response- Delivery of Healthcare

Respond to at least two postings by members of your group as follows:

• Continue engaging in the Discussion.
• Follow up on the peer feedback that was provided to you.
• Review the feedback that was provided to other colleagues and provide your perspective based on what you came across in your research.

Colleagues 1

Keona Wilson

Discussion Board 3: Continuum of Care Evaluation and Country Comparison

    In this week’s post, I intend to continue evaluating the continuum of care for unintentional motor-vehicle crashes in Des Moines, IA, and to further compare the United States healthcare delivery model with Sweden's outcome-driven approach to trauma care and reimbursement.

Aligning Reimbursement with Value (Value-Based Care Element)

      Reimbursement is calculated within the continuum and is typically volume-based, with providers paid separately for services rendered rather than for patient outcomes across the entire episode of care. One crucial potential improvement would be to transition to episode-based bundled payment models for motor vehicle injuries that link reimbursement to outcomes such as functional recovery, complication rates, and the avoidance of preventable readmissions. Based on findings from Porter & Lee (2013), value-based reimbursement models have been shown to promote care coordination, reduce unnecessary utilization, and improve quality by rewarding patient outcomes rather than service volume. (Porter & Lee, 2013). Having an aligned reimbursement strategy with value in Des Moines could encourage stronger collaboration among trauma centers, rehabilitation facilities, and outpatient services while reducing inefficiencies across the continuum model.

Be Safe (Institute of Medicine Aim)

     The IOM’s aim of safety underscores the importance of minimizing harm to patients during the delivery of care. (Institute of Medicine, 2001). While we know Des Moines has access to higher-quality body trauma services, motor vehicle injury patients are still among the most vulnerable to safety risks such as delayed follow-up, medication errors during transition of care, and an inconsistency with rehabilitation referrals. A key improvement method would be to implement standardized safety protocols across care transitions, which could include handoffs, medication reconciliation, and stricter post-discharge follow-up incentives for trauma patients. Further evidence suggests that implementing standardized safety practices within a more coordinated transition policy can significantly reduce adverse events and improve patient outcomes. (Berwick et al., 2008). By further implementing safety-focused practices across the continuum of care, Des Moines can reduce preventable harm and improve recovery outcomes for all patients injured in motor vehicle crashes.

Comparison with Sweden’s Healthcare Delivery Model

Compared with Des Moines, Sweden has a healthcare delivery model that closely aligns with value-based care principles, including value-based reimbursement. Sweden currently operates within a universal healthcare system where reimbursement structures are continuously emphasized by population health outcomes, efficiency, and patient safety, rather than focusing on the volume of services. Trauma care reimbursement is often supported by national data systems and registers that track outcomes, injury severity, and long-term recovery, enabling providers to stay up to date on performance and to improve care delivery. Research by the Organization for Economic Co-operation and Development suggested that Sweden's integrated reimbursement and quality measurement system has contributed to lower injury-related mortality rates and improved trauma system performance across its healthcare systems. (OECD, 2022). In direct contrast to Des Moines, reimbursement is often inconsistent, thereby limiting the need for coordinated safety incentives across care settings. Des Moines can learn from Sweden, where the use of outcome-based accountability and system-wide incentives can promote safer, higher-value care. However, it is worth noting that the United States has a different health care financing and policy system that may pose challenges to adopting similar models, rather than fully replicating the system.

References

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, health, and Cost. Health Affairs (Project Hope), 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759Links to an external site.Links to an external site.Links to an external site.

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press. https://doi.org/10.17226/10027Links to an external site.Links to an external site.Links to an external site.

OECD. (2022). Road safety annual report. Organization for Economic Co-operation and Development

Porter, M., & Lee, T. (2013). The strategy that will fix health care. Harvard Business Review. https://hbr.org/2013/10/the-strategy-that-will-fix-health-careLinks to an external site.Links to an external site.

Colleague 2

Angela Smith

My analysis focuses on Atlanta, Georgia, addressing the health issue of unintentional injuries (accidents), with Russia used as an international comparison for healthcare delivery.

Improvement Proposal: Aligning Reimbursement with Value

One improvement Atlanta’s healthcare system could make is expanding bundled payment and episode-based reimbursement models for trauma and injury-related care. Aligning reimbursement with value means paying providers based on patient outcomes and total cost of care rather than volume of services delivered (Harvard Business School Institute for Strategy & Competitiveness [HBS ISC], n.d.). For unintentional injuries, bundled payments covering emergency care, hospitalization, rehabilitation, and follow-up services would encourage coordination across providers, reduce unnecessary services, and incentivize better recovery outcomes (Shi & Singh, 2022). This approach supports prevention, efficient care transitions, and cost containment while improving patient outcomes.

Improvement Proposal: IOM Aim — Be Safe

To better meet the Institute of Medicine’s (IOM) aim to “be safe,” Atlanta could strengthen system-wide injury prevention and patient safety protocols, particularly in emergency and trauma settings. The IOM emphasizes reducing harm caused by care itself through standardized processes, reporting systems, and a culture of safety (Institute of Medicine [IOM], 2001). Implementing stronger reporting of near misses, expanding trauma simulation training, and standardizing safety checklists in emergency departments could reduce preventable errors and complications related to unintentional injuries (Heslip, n.d.). These strategies directly improve patient safety and align with value-based care by preventing costly adverse events.

Comparison of Healthcare Delivery Models: Atlanta vs. Russia

In the United States, healthcare delivery in Atlanta emphasizes fragmented, multi-payer systems with increasing adoption of value-based programs through CMS, such as bundled payments and quality-based incentives (CMS, 2022). However, measuring outcomes and cost for every patient remains challenging due to system complexity and varied reimbursement structures.

In contrast, Russia’s centralized healthcare system allows for more standardized data collection and national tracking of outcomes and costs, particularly for trauma and injury-related care. While Russia’s system struggles with resource limitations and quality variation, its centralized reporting offers a lesson in population-level outcome measurement and cost transparency. Atlanta could learn from this approach by improving interoperability and data integration across trauma centers, emergency services, and rehabilitation providers. Conversely, Russia could benefit from adopting stronger value-based incentives tied to quality and safety outcomes, an area where U.S. value-based programs are more advanced (Shi & Singh, 2022).

References

Harvard Business School Institute for Strategy & Competitiveness. (n.d.). Aligning reimbursement with value.
https://www.isc.hbs.edu/health-care/value-based-health-care/key-concepts/Pages/aligning-reimbursement-with-value.aspxLinks to an external site.

Heslip, N. (n.d.). Crossing the quality chasm. PolicyMedical.
https://assets.hcca-info.org/Portals/0/PDFs/Resources/library/Crossing%20the%20Quality%20Chasm.pdfLinks to an external site.

Institute of Medicine. (2001). Improving the 21st-century health care system. In Crossing the quality chasm: A new health system for the 21st century (pp. 39–60). National Academy Press.
https://nap.nationalacademies.org/read/10027/chapter/4Links to an external site.

Shi, L., & Singh, D. A. (2022). Delivering health care in America: A systems approach (8th ed.). Jones & Bartlett Learning.

U.S. Centers for Medicare & Medicaid Services. (2022, March 31). What are the value-based programs?
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-ProgramsLinks to an external site.