Healthc Pap
· 2020 Oct · PMID 33337300
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The National Health Service (NHS) in the UK is regarded by many as the world leader in sustainability. In this article, I present six main reasons for this. The first three reasons are that the UK passed appropriate legi...The National Health Service (NHS) in the UK is regarded by many as the world leader in sustainability. In this article, I present six main reasons for this. The first three reasons are that the UK passed appropriate legislation; a long-term strategy was developed; and a sustainability direction and delivery framework emerged for not only the NHS and the social system but also for its partner organizations in education. The UK has also committed resources, has a system of governance and accountability and continually reviews its current systems in a constant need for regeneration.
Healthc Pap
· 2020 Oct · PMID 33337299
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"Toward a Sustainable Health System: A Call to Action" speaks of the challenge that the climate crisis poses for health systems. The scale of the accelerating crisis will require that health systems adapt in response and..."Toward a Sustainable Health System: A Call to Action" speaks of the challenge that the climate crisis poses for health systems. The scale of the accelerating crisis will require that health systems adapt in response and also become visible champions for change, mitigating the environmental harms of their operation and mobilizing their social networks and leadership potential to build community resilience and transformative capacity. The authors pay principal attention to the issues of environmental sustainability and also review the linked challenges of social and economic sustainability, given the imperatives of environmental and social justice and the need for a revitalized economic vision to support livable futures. The authors' aim is to accelerate ambition in Canada, where coordinated effort and national leadership have been lacking. They close with recommendations to achieve a net-zero health system in Canada by or before 2050.
Healthc Pap
· 2020 Oct · PMID 33337298
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I am increasingly alarmed by climate change and environmental degradation. Many of you share my concerns, no doubt. I worry that we are not dealing with these issues in a manner that promises meaningful or timely results...I am increasingly alarmed by climate change and environmental degradation. Many of you share my concerns, no doubt. I worry that we are not dealing with these issues in a manner that promises meaningful or timely results, and I believe we must reorder our priorities. There is also a fundamental unfairness that runs through what is happening. Environmental harm compounds existing inequities within and among our communities, inequities between richer and poorer nations and, most insidiously, generational inequity - deferring the consequences of our inaction to a future generation. Adding to these concerns is the realization that in my own professional field, healthcare, we have given little thought to the sector's role in and responsibility for environmental sustainability. To date, these issues have not been part of the mainstream healthcare conversation.
Healthc Pap
· 2020 May · PMID 32687470
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Health systems are changing continuously, due to powerful forces such as scientific and technical advances, social and economic conditions and demography. Change affects health systems by disrupting their internal balanc...Health systems are changing continuously, due to powerful forces such as scientific and technical advances, social and economic conditions and demography. Change affects health systems by disrupting their internal balance, that is, the adjustment of supply and demand for healthcare. At a high level, the answer is to adopt a policy approach that covers and connects the three areas of patient experience, health outcomes and cost-effectiveness, similar to the "Triple Aim" or its numerous avatars. Closer to the action, at the level at which decisions about treatment or care are made, the current trend is to focus on the "value agenda."
Healthc Pap
· 2020 May · PMID 32687469
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Canada's two most populous provinces are moving toward activity-based funding (ABF) of hospitals. Although ABF may encourage greater value by improving cost-efficiency, it may decrease value in other respects. To address...Canada's two most populous provinces are moving toward activity-based funding (ABF) of hospitals. Although ABF may encourage greater value by improving cost-efficiency, it may decrease value in other respects. To address this trade-off, many jurisdictions have implemented value-based payment programs that modify ABF payments based on hospital performance on other aspects of value, such as outcomes and patient experience. In this article, the design and implementation of two value-based programs are reviewed: Australia's Pricing for Safety and Quality Program and Medicare's Hospital Value-Based Purchasing Program. The contrasts of these programs highlight key questions facing provincial payers in Canada to increase value from hospital spending.
Healthc Pap
· 2020 May · PMID 32687468
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Moving toward greater value in healthcare in Canada requires more than novel tools and policy levers. First, we need clear objectives, namely, value as defined across stakeholders with primacy given to patients and the p...Moving toward greater value in healthcare in Canada requires more than novel tools and policy levers. First, we need clear objectives, namely, value as defined across stakeholders with primacy given to patients and the public. Next, an unwavering commitment by payers, providers and system managers to pursue those definitions of value. At the most basic level, we need to remember whom the healthcare system is working for. Although numerous pilot projects and promising examples exist, pursuing value in healthcare in Canada will likely require a reassessment of some fundamental aspects of our healthcare systems. A pragmatic approach of learning from the successes and failures of current efforts combined with a major rethinking of the foundational and operating principles of our current systems may be required to get there from here.
Healthc Pap
· 2020 May · PMID 32687467
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The purpose of this commentary is to outline a vision for the future of value-based healthcare in provinces across Canada and offer a few suggestions for the requirements to make substantial gains in value, based on lear...The purpose of this commentary is to outline a vision for the future of value-based healthcare in provinces across Canada and offer a few suggestions for the requirements to make substantial gains in value, based on learnings from past initiatives. We declare as our premise that improving value in healthcare means to improve population health. The goal of improving population health means to improve both average quality of life and life expectancy and to reduce inequalities in these health outcomes. That is, to "shift and squeeze" the population health distribution, as Dr. Patricia Martens phrased it in the Emmett Hall lecture at the Canadian Health Services and Policy Research conference in 2014.
Healthc Pap
· 2020 May · PMID 32687466
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Canada is one of the world's highest per capita spenders on healthcare. Yet provinces consistently boast lackluster performance on important measures of their population's health and access to healthcare (Davis et al. 20...Canada is one of the world's highest per capita spenders on healthcare. Yet provinces consistently boast lackluster performance on important measures of their population's health and access to healthcare (Davis et al. 2014; Doty et al. 2020). Spurred by public reporting, unease among governments about how to fix the problem and the lack of obvious solutions, much discussion focuses on improving the "value" of spending on healthcare (Papanicolas et al. 2018; Shrank et al. 2019).
Healthc Pap
· 2020 Feb · PMID 32310755
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The 2015 merger of health authorities in Nova Scotia was aggressive in pursuit of greater value. The goal was to create an integrated, accountable care network across the entire province. Years of pent-up frustration, de...The 2015 merger of health authorities in Nova Scotia was aggressive in pursuit of greater value. The goal was to create an integrated, accountable care network across the entire province. Years of pent-up frustration, death by a thousand cuts, declining service and growing expectations merged into a slow, insidious bleeding of support for change. The lessons learned from Nova Scotia are vital to achieving a value-based health system. The article describes some of the barriers to progress and the steps needed to achieve the goal of a value-based healthcare system for Canadians.
Healthc Pap
· 2020 Feb · PMID 32310754
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Value-based healthcare (VBHC) can be interpreted in many ways depending on one's jurisdiction. Often it is used synonymously with cost-effectiveness. In Alberta, VBHC might more appropriately be termed "values-based heal...Value-based healthcare (VBHC) can be interpreted in many ways depending on one's jurisdiction. Often it is used synonymously with cost-effectiveness. In Alberta, VBHC might more appropriately be termed "values-based healthcare." This reflects our belief that a healthcare system should meet the needs and desires of its population and contribute to overall wellness. We therefore developed a framework based on the dimensions of quality, the Quadruple Aim and feasibility considerations, which enables us to assess and measure our system activities and initiatives to determine if they are in keeping with VBHC in the Alberta context.
Healthc Pap
· 2020 Feb · PMID 32310753
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If the goal of "value-based healthcare" (VBHC) is to promote health, the shift towards health promotion as fostering resilience of individuals through supportive systems and environments is grounded in the importance of...If the goal of "value-based healthcare" (VBHC) is to promote health, the shift towards health promotion as fostering resilience of individuals through supportive systems and environments is grounded in the importance of providing value or outcomes that matter to all patients. VBHC puts patients at the centre of healthcare, but critical questions include which patients and what services? Here we explore the importance of life-course considerations of a resilience-based definition of health and consider the role of a broader horizontal and vertical system and individual level integration to attain VBHC for children and families.
Healthc Pap
· 2020 Feb · PMID 32310752
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Global experience demonstrates that the transition of healthcare systems towards better value requires the collaboration of multiple actors, including health industry. Globally, several initiatives are already demonstrat...Global experience demonstrates that the transition of healthcare systems towards better value requires the collaboration of multiple actors, including health industry. Globally, several initiatives are already demonstrating the power of value-based partnerships between public and private sectors.
Healthc Pap
· 2020 Feb · PMID 32310751
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The movement away from traditional models to organize, finance and deliver healthcare toward integrated models focusing on delivering value has been under way in many health systems and jurisdictions in the world with va...The movement away from traditional models to organize, finance and deliver healthcare toward integrated models focusing on delivering value has been under way in many health systems and jurisdictions in the world with varying degrees of intensity and success for much of the past 20 years. I have had the opportunity to lead aspects of a multi-state health system committed to the concepts of accountable care during the first 10 years of the Patient Protection and Affordable Care Act (PPACA) in the US. For the past two years, I have assumed the role as CEO of a large academic health sciences centre in Ontario as the province embarks on a shift in policies to support integrated models of care delivery similar to those associated with the PPACA. I will describe my observations comparing two countries' move toward integrated delivery models and potential lessons for Canada.
Healthc Pap
· 2020 Feb · PMID 32310750
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A group with a broad representation of providers and engaged citizens (called, aptly enough, the Muskoka and Area Health Transformation, or MAHST) was formed to look for impediments to a sustainable health system in Musk...A group with a broad representation of providers and engaged citizens (called, aptly enough, the Muskoka and Area Health Transformation, or MAHST) was formed to look for impediments to a sustainable health system in Muskoka, and propose solutions. Eventually, this group recommended a single governance for all of its community's healthcare. The current effort to develop an Ontario Health Team (OHT) should bring this endeavour to reality.
Healthc Pap
· 2020 Feb · PMID 32310749
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Integrated healthcare models are being experimented with in many jurisdictions as a way to improve patient care and lower system costs. This commentary presents early lessons from one Ontario Health Team as it works towa...Integrated healthcare models are being experimented with in many jurisdictions as a way to improve patient care and lower system costs. This commentary presents early lessons from one Ontario Health Team as it works towards new models of care. The authors recount early discussions on developing an integrated health services network, how funding for "winter surge initiatives" became an opportunity to test ideas and how these experiences are informing current planning. Some of the early lessons learned include the value of trusted relationships, moving care upstream and framing problems as collective challenges.
Healthc Pap
· 2020 Feb · PMID 32310748
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Patients, caregivers, providers, provider organizations such as hospitals and provincial government funders each have their perspectives on how and when healthcare should be delivered and have expectations for its qualit...Patients, caregivers, providers, provider organizations such as hospitals and provincial government funders each have their perspectives on how and when healthcare should be delivered and have expectations for its quality, convenience and efficiency. These competing viewpoints on the value from healthcare have led many to wonder: what is the path for improving value from healthcare in provinces?
Healthc Pap
· 2019 Dec · PMID 31901069
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Publisher ↗
High-performing and equitable healthcare systems are influenced by the strength of primary healthcare (PHC), which means that there should be special attention on this sector because we are changing how we monitor and im...High-performing and equitable healthcare systems are influenced by the strength of primary healthcare (PHC), which means that there should be special attention on this sector because we are changing how we monitor and improve overall care. Comprehensive data are the foundation for actionable information and are urgently needed in PHC because of the heterogeneity in both the demographics and the healthcare needs of the populations served. An ideal information system would combine multiple data sources such as electronic medical records (EMRs), administrative data and patient-reported information, drawing on the strengths of each to develop a comprehensive view of PHC. The purpose of this commentary is to draw attention to data gaps and offer suggestions about where and how this information could be obtained. Linked patient experience, EMRs and administrative data could be used in a learning health system to support decisions at the practice level and the jurisdictional level, where resources (financial and human) can be deployed to improve the quality of care, particularly when care is needed across sectors. The information gained from the analysis of these data are of high value for clinician/practice quality improvement efforts and for regional and jurisdictional health system planning and resource allocation.
McCaughey D, McGhan G, Bele S
… +2 more, Sharma N, Ludlow NC
Healthc Pap
· 2019 Dec · PMID 31901068
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The exponential rise in healthcare costs in developed nations has sharpened the need for greater "value" in healthcare. Porter's (2010) seminal work is one of the most cited definitions and equation for value-based care....The exponential rise in healthcare costs in developed nations has sharpened the need for greater "value" in healthcare. Porter's (2010) seminal work is one of the most cited definitions and equation for value-based care. The pursuit of greater value in our healthcare system is of paramount importance, yet translating value-based healthcare (VBHC) into a framework that can be effectively utilized in the Canadian system remains a challenge. To address this challenge, we propose that VBHC can be adapted to fit the Canadian healthcare system through (1) visionary leadership for and conceptualization of VBHC at the federal government level and (2) thoughtful application of VBHC at the provincial government level. Our applied value in healthcare framework serves as a platform from which VBHC initiatives, programs and outcome measures can be systematically organized and executed within provincial healthcare systems. This methodical approach could support both provincial ministries and their health systems in pursuit of VBHC and provide the basis for explicit measurement of VBHC success, thereby helping to address the pressing issue of sustainability of the Canadian healthcare system while optimizing patient-centred outcomes of care.
Healthc Pap
· 2019 Dec · PMID 31901067
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Publisher ↗
What matters most to people who use healthcare? What matters to their caregivers? How do we use this information to support ongoing quality improvement in the healthcare system? In this paper, we explore three concepts f...What matters most to people who use healthcare? What matters to their caregivers? How do we use this information to support ongoing quality improvement in the healthcare system? In this paper, we explore three concepts from the current healthcare discourse, intended to drive health system improvements: person-centred care, value-based healthcare and learning health systems. We propose that key tenets from each of these concepts should be combined to create a person-centred learning health system (PC-LHS). We highlight two key points: First, in achieving a PC-LHS, the experiences, priorities and values of patients and their caregivers should be continually collected and fed into data systems to monitor ongoing quality improvement and performance benchmarking. Second, the information collected in determining value must include important contextual factors - including the social determinants of health - as patient health and well-being outcomes will ultimately be shaped by these factors, in addition to health system and disease factors. In summary, improving value for patients and caregivers, by capturing the things that matter most to them, within their life contexts, needs to be part of the continuous quality improvement cycle that lies at the heart of a learning health system.
Gilmore KJ, Pennucci F, De Rosis S
… +1 more, Passino C
Healthc Pap
· 2019 Dec · PMID 31901066
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Publisher ↗
A prevailing feature of recent healthcare delivery and reform initiatives is a focus on increasing the value provided by investment in services, alongside a more nuanced understanding of how such value should be consider...A prevailing feature of recent healthcare delivery and reform initiatives is a focus on increasing the value provided by investment in services, alongside a more nuanced understanding of how such value should be considered. Effective measurement of this value remains an elusive goal for most health system performance assessment (HSPA) systems. A more prominent role for the patient voice can enable a better understanding of value at both patient and population levels. The Tuscan HSPA model has evolved over the past several years by adopting the perspective of service users, including multiple dimensions of performance, and illustrating the interactions of these elements. For the heart failure pathway, this approach has now been further developed to combine these dimensions with the systematic electronic collection of patient-reported outcome measures and patient-reported experience measures - initially in a specialist hospital. This enables a richer understanding of the value delivered by professionals as they operate in reality, as opposed to by organizational boundaries, and more timely and actionable insights into the drivers of that value. This commentary sets out the latest developments in the Tuscan HSPA and the lessons from implementation.