Combined Regional Investments Could Substantially Enhance Health System Performance And Be Financially Affordable

Abstract

Leaders across the United States face a difficult challenge choosing among possible approaches to transform health system performance in their regions. The ReThink Health Dynamics Model simulates how alternative scenarios could unfold through 2040. This article compares the likely consequences if four interventions were enacted in layered combinations in a prototypical midsize US city. We estimated the effects of efforts to deliver higher-value care; reinvest savings and expand global payment; enable healthier behaviors; and expand socioeconomic opportunities. Results suggest that there may be an effective and affordable way to unlock much greater health and economic potential, ultimately reducing severe illness by 20 percent, lowering health care costs by 14 percent, and improving economic productivity by 9 percent. This would require combined investments in clinical and population-level initiatives, coupled with financial agreements that reduce incentives for costly care and reinvest a share of the savings to ensure adequate long-term financing.

Using a Stakeholder Analysis to Improve Systems Modelling of Health Issues: The Impact of Progesterone Therapy on Infant Mortality in Ohio

“…Under the capture and reinvest scenario (Homer et al ., ), savings from reducing preterm babies (i.e. hospital costs) would be used to finance interventions in the next period.…”

New approaches to measurement and management for high integrity health systems

“…[29][30][31][32][33][34][35][36][37][38] Measures and tools for teamwork and coordination of care, for balancing population health metrics to include what matters to patients, clinicians, and payers, for managing improvement and innovation, for aligning capabilities against priority activities, and for testing assumptions to assure expectations about the amount and timing of returns on investments in population health are gaining use in health systems. [29][30][31][32][33][34][35][36][37][38][39] Such tools have the potential to foster deeper, more informed partnerships with patients, communities, and the professional service providers in other sectors (including education, employment, as well as social care) who contribute to health and wellbeing. Introduction of this approach to advance the reform goals of NHS England is described in box 3.…”

“…31 The goal was to accelerate learning about how to implement new care models as building blocks for accountable care systems across England. Over six months, supported by the NHS England New Care Models Team and the Dartmouth Institute for Health Policy and Clinical Practice, the six teams performed several tasks: Using logic models they set priorities for learning how to better meet the needs and wants of priority populations, such as frail elderly people and children and adolescents with behavioural problems 40 They used Right Care's Commissioning for Value Packs derived from the NHS Atlas of Health Care to identify opportunities for improving outcomes and costs by making process variation visible 3 and to improve value by using shared decision making and care planning as a form of "micro-commissioning" to inform purchasing decisions made for populations 19 They considered embedding simple patient reported measures to gauge effort made by clinicians to learn what matters most to them after helping them understand their health problems 34 and care coordination to guide implementation of multidisciplinary teams and new care models designed for learning 35 They constructed "value compasses" to meet the needs of those accountable for quality and cost of care for populations while maintaining focus on what matters to patients [33][34][35][36][37][38][39][40][41] They considered the role of microsystems and related improvement science measures and tools to strengthen teamwork and improve safety and productivity 41…”

“…Using a systems dynamic model, they tested assumptions about health and wellbeing and financial returns on investments in acute care and community settings across health and social care 39 The PBCN pilot programme demonstrated that frontline clinicians and managers and purchasers of services were accepting of an integrated offering of measures and management tools to guide implementation of new care models. We need further evidence of acceptability in different contexts and of the effect of the integrated offering and its individual elements, even as such support programmes are refined and expanded in scope and scale.…”

Square peg in a round hole: re-thinking our approach to evaluating health system strengthening in low-income and middle-income countries

“…ABM and SDM are well-known methods for modelling complex sociotechnical dynamic systems, including the dynamic behaviour of an accident and emergency department23 24; accountable care organisations25; accountable care organisations25; policies to make care more affordable26; vaccine distribution systems27; and neonatal health policies28among many others (eg,  29). These models can be used to evaluate and quantify ex ante the response of a health system to any stimulus, including potential adverse events,30 be it for a new programme, or additional resources, a sudden disease outbreak or a natural disaster.…”