Category Archives: Healthcare Systems

Patient care, quality improvement, patient safety, value based care, accountable care

Value Based Healthcare Policy

Value-based payment models aim to increase value by improving outcomes and lowering costs. Though there are many possible approaches to achieve this aim, most models use some combination of care coordination and financial incentives/penalties tied to quality metrics. The reading provides a general overview of the types of value-based payment models.

READ: What is Value-Based Healthcare?

WATCH: The ABCs of ACOs for a brief overview of ACOs. Pay special attention to how they differ from HMOs.

WATCH: The Realities of PCMH through 30:00 for a discussion of PCMH. Pay special attention to how they compare to ACOs.

 

Value and Reducing Waste

Choosing Wisely: PDF

Things We Do for No Reason: PDF

Teachable Moment: PDF

American College of Radiology Appropriateness Criteria: PDF

Principles of High Value Care

Familiarize yourself with the definitions of cost and waste and their relationship to value. 

This module will introduce the definitions of cost and waste as well as their relationship to value. A key point is that cost can mean more than just financial impact so pay special attention to the downstream effects of a low-value intervention on a patient.

IHI Module TA103 

Safety Culture

1) Watch the video: “Building a psychologically safe workplace” (TED talk by Amy Edmonson).

GOAL: Develop awareness of psychological safety and its importance in teamwork.

 

Optional After class:

IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx

  • Supplementary activity to provide greater detail and context for the material covered in lecture.  Recommended for students pursing certificate in quality and safety.
  • GOAL: Improve understanding of culture of safety by providing additional examples.
    • PS 104 lessons 2-3
    • PS 202 Lesson 2

Introduction to Healthcare Systems

Review:

Review the fact sheet. Arrive to class familiar with content.

Fact Sheet on Healthcare Financing and Reform

Watch:

Search the Khan Academy website (khanacademy.org) and create a log-in. Locate the “Health Care System” modules.  To do this, first select the “Science” category, then “Health and Medicine”, then “Health Care System”.  All students should arrive to class capable of quickly accessing the Khan Academy website.

View Khan Academy Modules as necessary. Three Khan academy modules are listed below.  The content of these modules is summarized.  Students with background knowledge in the listed content and fact sheet content are NOT required to view the modules.  The modules are a supplementary assignment and should be completed as necessary based on student background and understanding of the US healthcare system and payment systems.  Note: students may need to access Khan Academy modules for small group work during the breakout session.

Module 1: Health care system overview (8 minutes)

Explains how patients/populations, providers, and payors interact.  Introduces government insurance, direct payment of patient to doctor, HMOs and PPOs.  Explains the rationale for insurance to mitigate risk and discusses the need to manage “moral hazard” as well as over-utilization of services when not directly responsible for payment.

Module 2: Paying doctors (12 minutes)

Defines FFS, capitation and salary.  Describes the lack of cost accountability to patients and providers in the third party payor system.  Describes issues with capitation with particular attention on “cherry picking” or patient shifting.

Module 3: Medicare overview  (16 minutes)

Introduces Medicare and Medicaid.  Defines populations covered for Medicare (Elderly/ALS/ESRD) and Medicaid (low income) as well as funding source (Federal Government for Medicare and combined Federal and State for Medicaid).  Defines Secretary of HHS and CMS (Centers of Medicare and Medicaid Services).  Describes Medicare parts A-D.

 

Social Ecological Model

Social Ecological Model

McLeroy, Bibeau, Steckler and Glanz are generally credited with creating the social ecological model of care.  A quick Google search for the social ecological model will reinforce how widely it has been adopted.  There are numerous community, state, national and international organizations that utilize this model in their programs.

Think back to your session in immersion on the social history.  How often do you think beyond the individual and interpersonal factors that influence you and your patients health?

Image result for social ecological model uw

 

From CDC Colorectal Cancer Control Program (CRCCP)

What is Health?

The Oxford English Dictionary defines health as “the state of being free from illness or injury.”  

The constitution of The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Fiona Goodlee, editor of the British Medical Journal and the editorial staff at The Lancet have both written editorials about the evolving definition of health.  Click on the below links to read the two articles.  Read the articles with the below questions in mind.

As you progress throughout your medical student career (and beyond) we would encourage you to return to this page to reflect upon:

  • How do you currently define health?
  • How has the definition of health changed over time?
  • Does the definition of health change by perspective?  Is health defined differently in the United States that it is in other countries?
  • Do patients define health differently than their physicians?
  • Does the public health system define health differently than hospitals?
  • How are medical schools accountable for health?