Week 7 Discussion Response- Delivery of Healthcare

Colleague 1

Kristina Rivera

 This evaluation focuses on Boise, Idaho, addresses myocardial infarction as the identified heart disease health condition and compares the U.S. Healthcare delivery model to the Netherlands.

Improvement based on Systems Integration

A key improvement would be the development of a fully integrated, condition-specific cardiovascular care pathway that formally connects primary care, cardiology, acute care, and cardiac rehabilitation through standardized communication, shared performance metrics and real time date exchange. Although current care delivery systems access multiple services points leaving opportunities to strengthen integration by ensuring proactive coordination across settings.

Harvard Business School Institute for Strategy & Competitiveness (n.d). states, “effectively integrated care in multiple location sis an essential element of value-based health care delivery systems…When provider integrate care across a network of facilities, and in conjunction with community resources, the add value for patients, providers and the system as a whole.” The emphasizes that integrated practice units organize around a medical condition, improve outcomes and reduce costs by aligning multidisciplinary teams. This could be achieved by implementing a myocardial infarction focused care team that included primary care providers, cardiologists, inpatient clinicians, pharmacists, rehabilitation specialists and care coordinators who joint manage treatment plans and transition care.  Embedding shared clinical protocols, automatic alerts for abnormal diagnostics and post discharge follow up workflows within the electronic health record would reduce fragmentation, minimize delays in treatment and prevent avoidable readmissions.

IOM Aim: Be efficient

An improvement would be the implementation of standardized, evidence-based myocardial infarction car pathways combined with reduced duplication of diagnostic testing across the continuum of care in Boise. While the hypothetical patient’s care involved appropriate escalation from primary care to cardiology and acute intervention, efficiency could be enhanced by ensuring that diagnostics results, treatment decisions, and care plans are streamlined and automatically shared across all settings to avoid unnecessary delays, repeated testing and excess costs.

Heslip (n.d.) stated “manual policy management is inefficient in the sense that it eats up a hospital’s time, financial and human resources, all of while should be devoted to direct patient care.” Efficiency in health care is achieved by avoiding waste, including unnecessary tests, procedures, and administrative complexity. In the Boise care model, greater use of protocol driven decision support reduce variation in care while preserving quality. Examples include standardized triggers for cardiology referral, imaging and intervention. By focusing on eliminating redundant services and enhancing coordination, Boise’s health system could deliver more efficient, high value care for myocardial infarction patients.

Comparative Delivery Systems

To better understand how Boise’s health delivery model compares internation in terms of system integration, the Netherlands offer a strong example of coordinated, value-based care. The Dutch healthcare system emphasizes strong integration through mandatory health insurance, robust primary care gatekeeping and regional care networks that coordinate service across providers and settings. A key lesson for Boise is the value of regional integration supported by shared outcomes data and aligned incentives. While electronic health records such as MyChart support information sharing, care delivery remains influenced by a fragmented, multi-payer reimbursement structure that can limit full integration across the continuum.

Government involvement plays a central role in facilitating coordination by creating the conditions necessary for regional integration and aligning incentive across providers. Mjaset, et. al. (2020) states, “Government involvement can facilitate change by setting the right conditions (e.g., for regional system integration). Continuous IT improvements to ensure the availability of outcome data across the full care cycle and instituting a value-based culture among providers are keys to driving VBHC implementation.” This approach allows providers in the Netherlands to share responsibility for outcomes, costs, and long-term patient management.

References

Harvard Business School Institute for Strategy & Competitiveness. (n.d.). Systems integrationLinks to an external site.Links to an external site.. https://www.isc.hbs.edu/health-care/value-based-health-care/key-concepts/Pages/systems-integration.aspx

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

Mjåset, C., Ikram, U., Nagra, N. S, & Feeley, T. W. (2020, November 10). Value-based health care in four different health care systemsLinks to an external site.Links to an external site.. NEJM Catalyst, 1(6), 1–23. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0530

Colleague 2

Gisselle Meza

Community, Diagnosis, and Country Comparison

The health community under consideration can be found in Denver, Colorado, where malignant neoplasms (cancer) were spotted as the health problem, and the country chosen for comparison is Canada. Cancer is a major cause of death and illness in Denver and, accordingly, demands a comprehensive, persistent, and thus coordinated care system. Comparing Denver’s healthcare system with Canada’s integrated national model provides insight into how system-level organization affects access to care, efficiency, and patient outcomes.

Value-Based Care Improvement: Systems Integration

One notable change that could be implemented in Denver's cancer care continuum, particularly from the perspective of value-based care within systems integration, is the expansion of coordinated care models that formally link primary care practitioners, cancer experts, hospitals, and community-based support services. According to Shi and Singh, the integration of systems enhances continuity of care by reducing fragmented care resulting from a lack of collaboration, shared responsibilities, and continuity of care across different healthcare facilities. Even though Denver is equipped with top-notch cancer treatment facilities, patients, especially those who are underserved, low-income, or are from linguistically isolated populations, encounter difficulties in care transitions, delays in follow-up, and the lack of navigation assistance.

The strengthening of interoperable electronic health records and the implementation of multidisciplinary care teams would enable health care providers to share real-time patient information, align treatment plans, and reduce the duplication of services. Moreover, oncology care navigators’ utilization could facilitate patients’ understanding of their conditions, medication adherence, and access to supportive services, such as transportation, financial counseling, and palliative care. These methods would not only be consistent with value-based care principles but also enhance patient-centered outcomes.

IOM Aim Improvement: Be Efficient

A change supporting the Institute of Medicine's (IOM) aspiration to improve efficiency would require all hospitals in Denver to use uniform, evidence-based oncology care pathways. The IOM considers efficiency to be the process that results in the least waste, in terms of time, resources, and effort, and at the same time, the highest-quality care. Cancer treatment is to a large extent inefficient because of excessive testing, scattered referrals, and unnecessary hospital stays.

By establishing the same diagnostic and treatment protocols across all hospitals, Denver would be able to eliminate unnecessary imaging, expedite referrals, and facilitate the coordination of patients' care. Moreover, efficient scheduling systems and integrated care planning would eliminate delays in the initiation of treatment, thereby reducing the burden on patients. This way, healthcare organizations would be able to redistribute their resources more effectively without compromising quality or safety, and this would ultimately be a win-win situation for both patients and providers.

Comparison of Healthcare Delivery Models: Denver vs. Canada

Canada's healthcare delivery system is closely aligned with the value-based care principle of systems integration, as its publicly funded, single-payer model focuses on coordinating care among primary, specialty, and hospital services. This model facilitates cancer patients' access to screening, diagnosis, and treatment with minimal financial and administrative barriers, thereby promoting continuity and equity of care (Shi and Singh). Integrated care pathways and centralized planning help to support consistent follow-up and population-level cancer management.

Denver could take a page from Canada’s playbook by emphasizing coordination and universal access, particularly to reduce disparities linked to insurance coverage and healthcare costs. On the other hand, one drawback of Canada’s healthcare system is that patients must wait long periods before accessing certain oncology services, thereby delaying the start of treatment. This demonstrates the importance of a schedule that integrates and ensures timely access. Denver might implement stronger coordination strategies while maintaining flexibility, innovation, and responsiveness in its healthcare system.

Works Cited

Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press, 2001.

Seabert, David M., John F. McKenzie, and Robert R. Pinger. McKenzie’s Introduction to Community & Public Health. 10th ed., Jones & Bartlett Learning, 2022.

Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America: A Systems Approach. 8th ed., Jones & Bartlett Learning, 2022.

World Health Organization. “COVID-19 Transmission and Protective Measures.” World Health Organization, www.who.intLinks to an external site..

Additional Post:

Since enough peers haven't posted for me to respond, the professor suggested that I respond to my initial post (Week 7 Discussion) which is attached...

In one or two paragraphs, please respond to your initial post reflecting additional insight you've gained since your initial and peer response posts with consideration of the following (or similar) questions. Indicate Second Feedback Response - Dr. Sheryl.

• After rereading your post, how well do you think it reflects leadership principles across the continuum of care?
• What new insight did you gain about leadership’s role in coordinating care across settings?
• How might this learning influence your future leadership or decision-making in healthcare?
• What is one specific improvement you would make to enhance clarity, depth, or impact?