Week 8 Discussion Response (2)- 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.

Value Based Care Model: Geography of Care

An improvement aligned with the value-based care element of geography of care would be the intentional regionalization of myocardial infarction services across Boise. Although Boise offers advanced cardiac services through healthcare services, access to timely specialty care can vary based on location, particularly patients residing in outlying areas of Ada County and neighboring regions. Optimizing the geography of care would ensure that patients receive the right level of care in the most appropriate setting, rather than defaulting to high-cost acute care facilities.

Value based care requires organizing services so that routine and preventative care is delivered close to where patients live, while highly specialized service is centralized in high-volume centers to improve outcomes and efficiency. For Boise, this could include expanding telecardiology services for rural primary care clinics, enabling rapid consultation, early diagnosis and medication management without necessarily travel or emergency department use. Harvard Business School Institute for Strategy and Competitiveness (n.d.) stated, “S While that strategy was effective when hospitals had little to offer, the increasing complexity of medical care today means that every hospital should not be performing highly complex procedures or treating exceeding complex patients. Not every hospital needs a heart transplant program, or even cardiac surgery, yet that is what has happened in US health care expansion today.” Standardized regional STEMI transfer protocols and partnership with smaller, more rural community hospitals could ensure that patients experiencing acute MI are rapidly transported to designated cardiac centers, while post-acute follow up and cardiac rehabilitation are delivered closer to home through community based or virtual programs. By aligning services with geographic need, Boise could reduce delays in care, improve equity of access and lower costs while maintaining high-quality outcomes.

IOM Aim of Be Timely

An improvement alighted with the IOM Aim of being timely would be the implementation of an integrated, pre-hospital and emergency department myocardial infraction activation protocol that reduces delays from symptom onset to definitive treatment. Although Boise has access to advanced cardiac services, opportunities remain to shorten critical time interval particularly door-to-balloon times and transition from outpatient or emergency care to interventional cardiology.

In Boise, this aim could be advanced by expanding the use of emergency medical services (EMS) pre-arrival electrocardiogram (ECG) transmission and automatic cardiac catheterization lab activation for suspected MI cases. Pre-hospital ECGs and early activation of cardiac teams significantly reduce treatment delays and improve survival outcomes for patients with acute MI. Heslip (n.d) stated, “then we find out that the one disseminated doesn’t include all the input and that the wrong version was given to staff. When we must send an alert to staff rescinding the last version, we create feelings of mistrust toward the process and lack of confidence in the quality of information. Additionally, the ability to standardize discharge processes across the continuum of care. By reducing delays at each transition point, Boise’s healthcare system could better align to the IOM Aim of timely care while improving outcomes and patient experiences.

Healthcare Country Comparison

When examining the value-based care element of geography of care, the Netherlands provides a strong comparison to Boise’s healthcare delivery model. In Boise, care for conditions such as myocardial infarction is concentrated within urban hospital systems where advance cardiac services are readily available. Patients living outside the immediate metropolitan area may experience longer travel times and delays in accessing specialized services, resulting in geographic variation in care delivery. Telehealth and referral networks are in place; however, care remains largely centered around high-acuity hospital settings.

In contract, the Dutch healthcare system is intentionally organized around regional care delivery, ensuring that patient receive care at the most appropriate location based on disease complexity. Primary care is delivered locally through general practitioners, whole serve as gatekeepers, while specialized services are centralized in high volume regional centers to optimize patient outcomes. Post-acute service is shifted by into community or home-based settings, maintaining proximity to the patient.

A key positive lesson for Boise is the value of regional planning that deliberately separates routines, specialized and recovery care across geographic settings. Expanding community based cardiac rehabilitation, telecardiology follow up and partnerships with rural clinics could reduce travel burdens while maintaining quality. A potential challenge is that the Netherland benefit from national planning and uniform insurance requirements, whereas Boise operates within planning and uniform insurance requirements whereas Boise operates within a fragmented, multiplayer system that limits centralized geographic coordination. Mjaset, et. al (2020) stated, “Understanding of these strengths and weaknesses can yield insights for policymakers and providers as they strive for a more patient-focused, value-based care delivery environment. Government involvement can facilitate change by setting the right conditions (e.g., for regional system integration).” Adopting regional service planning and clearer care routing protocols could help Boise better align care delivery with patient location, improving access outcomes and overall value.

References:

Harvard Business School Institute for Strategy & Competitiveness. (n.d.). Geography of careLinks to an external site.Links to an external site.. https://www.isc.hbs.edu/health-care/value-based-health-care/key-concepts/Pages/geography-of-care.aspxLinks to an external site.

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

Hypertension Care: Value-Based and Timely Delivery

In Keansburg, New Jersey, the control of hypertension among adult patients can be made more effective through value-based and community-based strategies, with reference to the primary care system in Australia. The theory of decentralized care delivered through community-based clinics and pharmacies could reduce reliance on hospital-based services and enhance access (Harvard Business School, 2026). Timely diagnosis and early initiation of treatment are facilitated by same-day blood pressure checks and telehealth nurse follow-ups. The Australian model emphasizes effective primary care coordination, regional integration, and the expanded role of nurses in managing chronic diseases in Australia (Institute of Medicine, 2001; Hirpa et al., 2020). Modifying the aforementioned strategies for Keansburg can improve hypertension outcomes without compromising efficiency, accessibility, or continuity of care, and without causing congestion.

References

Harvard Business School. (2026). Geography of Care. Institute For Strategy And Competitiveness. https://www.isc.hbs.edu/health-care/value-based-health-care/key-concepts/Pages/geography-of-care.aspxLinks to an external site.

Hirpa, M., Woreta, T., Addis, H., & Kebede, S. (2020). What matters to patients? A timely question for value-based care. PLoS One, 15(7), e0227845. https://doi.org/10.1371/journal.pone.0227845Links 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 Academies Press. https://doi.org/10.17226/10027