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van Staalduinen DJ, van den Bekerom P, Groeneveld S, Kidanemariam M, Stiggelbout AM, van den Akker-van Marle ME. The implementation of value-based healthcare: a scoping review. BMC Health Serv Res 2022; 22:270. [PMID: 35227279 PMCID: PMC8886826 DOI: 10.1186/s12913-022-07489-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/11/2022] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study was to identify and summarize how value-based healthcare (VBHC) is conceptualized in the literature and implemented in hospitals. Furthermore, an overview was created of the effects of both the implementation of VBHC and the implementation strategies used. Methods A scoping review was conducted by searching online databases for articles published between January 2006 and February 2021. Empirical as well as non-empirical articles were included. Results 1729 publications were screened and 62 were used for data extraction. The majority of the articles did not specify a conceptualization of VBHC, but only conceptualized the goals of VBHC or the concept of value. Most hospitals implemented only one or two components of VBHC, mainly the measurement of outcomes and costs or Integrated Practice Units (IPUs). Few studies examined effects. Implementation strategies were described rarely, and were evaluated even less. Conclusions VBHC has a high level of interpretative variability and a common conceptualization of VBHC is therefore urgently needed. VBHC was proposed as a shift in healthcare management entailing six reinforcing steps, but hospitals have not implemented VBHC as an integrative strategy. VBHC implementation and effectiveness could benefit from the interdisciplinary collaboration between healthcare and management science. Trial registration This scoping review was registered on Open Science Framework https://osf.io/jt4u7/ (OSF | The implementation of Value-Based Healthcare: a Scoping Review). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07489-2.
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Affiliation(s)
- Dorine J van Staalduinen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300RC, Leiden, The Netherlands. .,Institute of Public Administration, Leiden University, Turfmarkt 99, 2511 DP, The Hague, The Netherlands.
| | - Petra van den Bekerom
- Institute of Public Administration, Leiden University, Turfmarkt 99, 2511 DP, The Hague, The Netherlands
| | - Sandra Groeneveld
- Institute of Public Administration, Leiden University, Turfmarkt 99, 2511 DP, The Hague, The Netherlands
| | - Martha Kidanemariam
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300RC, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300RC, Leiden, The Netherlands
| | - M Elske van den Akker-van Marle
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300RC, Leiden, The Netherlands
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Arabadjis SD, Sullivan EE. Data and HIT systems in primary care settings: an analysis of perceptions and use. J Health Organ Manag 2021; ahead-of-print. [PMID: 33354961 DOI: 10.1108/jhom-03-2020-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Electronic Health Records (EHRs) and other Health Information Technologies (HITs) pose significant challenges for clinicians, administrators and managers in the field of primary care. While there is an abundance of literature on the challenges of HIT systems in primary care, there are also practices where HITs are well-integrated and useful for care delivery. This study aims to (1) understand how exemplary primary care practices conceptualized data and HIT system use in their care delivery and (2) describe components that support and promote data and HIT system use in care delivery. DESIGN/METHODOLOGY/APPROACH This paper is a sub-analysis of a larger qualitative data set on exemplary primary care in which data was collected using in-depth interviews, observations, field notes and primary source documents from week-long site visits at each organization. Using a combination of qualitative analysis methods including elements of thematic analysis, discourse analysis, and qualitative comparison analysis, we examined HIT-related data across six exemplary primary care organizations. FINDINGS Three key components were identified that underlie engagement with data and HIT systems: data audience identification, defined data purpose and structures for participation in both data design and maintenance. ORIGINALITY/VALUE Within the context of primary care, these findings have implications for effective integration of HIT systems into primary care delivery.
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Affiliation(s)
- Sophia D Arabadjis
- Geography, University of California Santa Barbara, Santa Barbara, California, USA
| | - Erin E Sullivan
- Sawyer Business School, Suffolk University, Boston, Massachusetts, USA.,Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA
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Dauner KN, Loomer L. A qualitative assessment of barriers and facilitators associated with addressing social determinants of health among members of a health collaborative in the rural Midwest. BMC Health Serv Res 2021; 21:867. [PMID: 34429097 PMCID: PMC8384464 DOI: 10.1186/s12913-021-06859-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose Rural communities have unique economic and social structures, different disease burdens, and a more patchworked healthcare delivery system compared to urban counterparts. Yet research into addressing social determinants of health has focused on larger, urban, integrated health systems. Our study sought to understand capacities, facilitators, and barriers related to addressing social health needs across a collaborative of independent provider organizations in rural Northeastern Minnesota and Northwestern Wisconsin. Methods We conducted qualitative, semi-structured interviews with a purposive sample of 37 key informants from collaborative members including 4 stand-alone critical access hospitals, 3 critical access hospitals affiliated with primary care, 1 multi-clinic system, and 1 integrated regional health system. Findings Barriers were abundant and occurred at the organizational, community and policy levels. Rural providers described a lack of financial, labor, Internet, and community-based social services resources, a limited capacity to partner with other organizations, and workflows that were less than optimal for addressing SDOH. State Medicaid and other payer policies posed challenges that made it more difficult to use available resources, as did misaligned incentives between partners. While specific payer programs and organizational innovations helped facilitate their work, nothing was systemic. Relationships within the collaborative that allowed sharing of innovations and information were helpful, as was the role leadership played in promoting value-based care. Conclusions Policy change is needed to support rural providers in this work. Collaboration among rural health systems should be fostered to develop common protocols, promote value-based care, and offer economies of scale to leverage value-based payment. States can help align incentives and performance metrics across rural health care entities, engage payers in promoting value-based care, and bolster social service capacity.
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Affiliation(s)
- Kim Nichols Dauner
- Department of Economics and Health Care Management, Labovitz School of Business & Economics, University of Minnesota Duluth, 1318 Kirby Drive, Duluth, MN, 55812, USA.
| | - Lacey Loomer
- Department of Economics and Health Care Management, Labovitz School of Business & Economics, University of Minnesota Duluth, 1318 Kirby Drive, Duluth, MN, 55812, USA
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Accountable Care Program Implementation and Effects on Participating Health Care Systems in Washington State: A Conceptual Model. J Ambul Care Manage 2020; 42:321-336. [PMID: 31449166 DOI: 10.1097/jac.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study is based on key informant interviews with health care executives representing 5 large health systems that had entered into contracts with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. The purpose of this study was to explain effects of accountable care program (ACP) implementation on participating health care systems. Between January 2017 and May 2018, we conducted 2 rounds of semistructured interviews (n = 20). Results indicate the need to present a modified conceptual model aligned with ACP implementation in the current context.
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Lin SC, Hollingsworth JM, Adler-Milstein J. Alternative payment models and hospital engagement in health information exchange. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:e1-e6. [PMID: 30667611 PMCID: PMC6526138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess whether hospital participation in alternative payment models (APMs) is associated with greater engagement in health information exchange (HIE) along 4 dimensions: volume of patients for whom information is exchanged, diversity of information types, breadth of partner types, and depth of technical approach. STUDY DESIGN Pooled, cross-sectional analysis of data on US hospitals from 2014 to 2015. METHODS APM participation came from Leavitt Partners data, Medicare public use files, and the American Hospital Association (AHA) Annual Survey. We used Medicare data to measure HIE volume for 798 hospitals attesting to stage 2 Meaningful Use and the AHA Information Technology Supplement to measure HIE diversity, breadth, and depth for 1730 hospitals. We used mixed-effects regression to estimate the association between participation in APMs and each dimension of HIE. RESULTS Compared with nonparticipating hospitals, full-year APM participation was associated with lower HIE volume (data were sent for 11 percentage points fewer discharges; P = .003), greater HIE diversity (of 4 data types, 0.3 more were transmitted; P <.001), greater HIE breadth (of 3 partner types, data were sent to 0.3 more; P <.001), and greater HIE depth (the odds of using a push and pull approach were 1.68 times greater; P = .004). CONCLUSIONS Our finding that APM participation was associated with greater HIE diversity, breadth, and depth suggests that value-based payment may be spurring improvements in HIE infrastructure. However, our finding that APM participation is associated with lower HIE volume suggests that there may be an incentive to focus HIE investments on a limited number of partners.
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Affiliation(s)
- Sunny C Lin
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109.
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McAlearney AS, Walker DM, Hefner JL. Moving Organizational Culture from Volume to Value: A Qualitative Analysis of Private Sector Accountable Care Organization Development. Health Serv Res 2018; 53:4767-4788. [PMID: 30047138 DOI: 10.1111/1475-6773.13012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The concept of shifting from volume (i.e., billing for as many patients and services as possible) to value (i.e., reducing costs while improving quality) has been a key underpinning of the development of accountable care organizations (ACOs), yet the cultural change necessary to make this shift has been previously unexplored. DATA SOURCES/STUDY SETTING Primary data collected through site visits to four private sector ACOs. STUDY DESIGN Cross-sectional, semi-structured interview study with analysis done at the ACO level to learn about ACO development. DATA COLLECTION One hundred and forty-eight interviews recorded and transcribed verbatim followed by rigorous qualitative analysis using a grounded theory approach. PRINCIPAL FINDINGS The importance of shifting organizational culture from volume to value was emphasized across sites and interviewees, particularly when defining an ACO; describing the shift in organizational focus to value; and discussing how to create value by emphasizing quality over volume. Value was viewed as more than cost-benefit, but rather encapsulated a paradigmatic cultural change in the way care is provided. CONCLUSIONS We found that moving from volume to value is central to the culture change required of an ACO. Our findings can inform future efforts that aim to create a more effective value-based health care system.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST) in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH
| | - Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.,CATALYST, College of Medicine, The Ohio State University, Columbus, OH
| | - Jennifer L Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.,CATALYST, College of Medicine, The Ohio State University, Columbus, OH
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Rangachari P. Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success. ACTA ACUST UNITED AC 2018; 5:1-14. [PMID: 29546884 DOI: 10.2147/ieh.s151040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
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Affiliation(s)
- Pavani Rangachari
- College of Allied Health Sciences, Augusta University, Augusta, Georgia, United States
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