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Amado GC, Ferreira DC, Nunes AM. Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment? Int J Health Plann Manage 2022; 37:1252-1298. [PMID: 34981855 DOI: 10.1002/hpm.3407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/27/2021] [Accepted: 12/09/2021] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment. OBJECTIVES This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access. METHODS We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access. RESULTS A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures. CONCLUSIONS In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent growing trend in the number of studies suggests a promising future on the analysis of this topic.
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Affiliation(s)
- Guilherme C Amado
- Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Diogo C Ferreira
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Alexandre M Nunes
- Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, Lisbon, Portugal
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Reitblat C, Bain PA, Porter ME, Bernstein DN, Feeley TW, Graefen M, Iyer S, Resnick MJ, Stimson CJ, Trinh QD, Gershman B. Value-Based Healthcare in Urology: A Collaborative Review. Eur Urol 2021; 79:571-585. [PMID: 33413970 DOI: 10.1016/j.eururo.2020.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT In response to growing concerns over rising costs and major variation in quality, improving value for patients has been proposed as a fundamentally new strategy for how healthcare should be delivered, measured, and remunerated. OBJECTIVE To systematically review the literature regarding the implementation and impact of value-based healthcare in urology. EVIDENCE ACQUISITION A systematic review was performed to identify studies that described the implementation of one or more elements of value-based healthcare in urologic settings and in which the associated change in healthcare value had been measured. Twenty-two publications were selected for inclusion. EVIDENCE SYNTHESIS Reorganization of urologic care around medical conditions was associated with increased use of guidelines-compliant care for men with prostate cancer, and improved outcomes for patients with lower urinary tract symptoms. Measuring outcomes for every patient was associated with improved prostate cancer outcomes, while the measurement of costs using time-driven activity-based costing was associated with reduced resource utilization in a pediatric multidisciplinary clinic. Centralization of urologic cancer care in the UK, Denmark, and Canada was associated with overall improved outcomes, although systems integration in the USA yielded mixed results among urologic cancer patients. No studies have yet examined bundled payments for episodes of care, expanding the geographic reach for centers of excellence, or building enabling information technology platforms. CONCLUSIONS Few studies have critically assessed the actual or simulated implementation of value-based healthcare in urology, but the available literature suggests promising early results. In order to effectively redesign care, there is a need for further research to both evaluate the potential results of proposed value-based healthcare interventions and measure their effects where already implemented. PATIENT SUMMARY While few studies have evaluated the implementation of value-based healthcare in urology, the available literature suggests promising early results.
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Affiliation(s)
- Chanan Reitblat
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Business School, Boston, MA, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Michael E Porter
- Harvard Business School, Boston, MA, USA; Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - David N Bernstein
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA; Harvard Combined Orthopedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
| | - Thomas W Feeley
- Harvard Business School, Boston, MA, USA; Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Markus Graefen
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA; Embold Health, Nashville, TN, USA
| | - C J Stimson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quoc-Dien Trinh
- Harvard Medical School, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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