Redesigning Care Delivery In Response To A High-Performance Network: The Virginia Mason Medical Center

Pham, Hoangmai H.; Ginsburg, Paul Β.; McKenzie, Kelly; Milstein, Arnold

doi:10.1377/hlthaff.26.4.w532

Cited by 45 publications

(24 citation statements)

References 2 publications

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“…26 An exception is the experience of the Virginia Mason Medical Center in Seattle, WA in changing the care pathway for individuals presenting with LBP. 47 In the summer of 2004, the insurance company Aetna gave Virginia Mason notice that their specialty practices cost up to twice as much as other top local practices for the same care. 27 This resulted in Virginia Mason studying the care process for LBP and noting a lack of standardized, evidence-based procedures.…”

Section: Potential Pathways To Lower Imaging: the Virginia Mason Examplementioning

confidence: 99%

Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good

Flynn

Smith²,

Chou³

2011

J Orthop Sports Phys Ther

124

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Section: Potential Pathways To Lower Imaging: the Virginia Mason Examplementioning

confidence: 99%

Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good

Flynn

Smith²,

Chou³

2011

J Orthop Sports Phys Ther

124

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“…Organisations such as these have been shown to deliver high-value care at lower costs. 90,91 Advocate for integrated systems of care that maximise value…”

Section: Convert Health Care Institutions Into Rapidly Learning Organmentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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“…3 It penalizes organizations that try to reduce unnecessary services or shift patients into low-cost settings with reduced revenues and profits, creating a sizable barrier to delivery reform. 4 FFS also encourages overuse of many costly specialty services while shortchanging important but less lucrative areas such as primary care. Welldocumented inaccuracies in Medicare hospital and physician payment have made certain services highly profitable and others money-losers.…”

Section: Option 1: Recalibrate Ffs Paymentsmentioning

confidence: 99%

Payment Reform Options: Episode Payment Is A Good Place To Start

2009

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New strategies to control U.S. health spending growth are urgently needed. Although provider payment cuts are likely, cutting fee-for-service (FFS) payments will hurt quality and access. A more sensible approach would be to restructure the delivery system into organized networks of providers delivering reliable, evidence-based care. But restructuring will not occur without payment policy reform. Four policy options are commonly cited: recalibrating FFS, instituting pay-for-performance, creating episode-based payments, and adopting global payments. We argue that episode payments are the most immediately viable approach, and we recommend that payment reforms precede any payment reductions so that new delivery models can gain traction. [Health Affairs 28, no. 2 (2009) T h e r e i s s t r o n g c o n s e n s us t h at t h e U.S. health care system fails to provide either the quality or the value that it should, and that substantial restructuring is urgently needed. 1 Despite deep dysfunction and numerous public and private reform efforts, the system has been astoundingly resistant to change. 2 But health spending has reached a level where continued annual increases two to three percentage points faster than the nation's economic growth will increasingly limit the ability of employers and public programs to offer health coverage. Unless the forty-year historical spending trend miraculously abates, vigorous expansion of public and private cost control initiatives is inevitable.Of the strategies capable of immediately slowing growth in health spending, reducing benefits and limiting services run counter to the urgent need to improve health care access. This leaves provider payment cuts as the "least bad" option for achieving short-term savings. However, in the fragmented U.S. delivery system, cutting fee-for-service (FFS) payments over any sustained time period will hurt w 2 6 2 2 7 J a n u a r y 2 0 0 9 C o m m e n t a r y

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Redesigning Care Delivery In Response To A High-Performance Network: The Virginia Mason Medical Center

Cited by 45 publications

References 2 publications

Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good

Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good

Ten clinician-driven strategies for maximising value of Australian health care

Payment Reform Options: Episode Payment Is A Good Place To Start

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