Care Delivery Value Chain (CDVC) and Integrated Practice Unit

Care Delivery Value Chain (CDVC) and Integrated Practice Unit for Ledina Lushko Sullivan University Healthcare Management 510 Ahmad Damra

Care Delivery Value Chain (CDVC) and Integrated Practice Unit Introduction This case study talking about 62 year old healthy Albanian woman who diagnosed in 2008 by metastatic Adrenocortical Carcinoma; which is a rare aggressively metastatic cancer of

the adrenal gland that can alter many functions of the bodys vital organs. Because the symptoms of the disease presented after the disease had reached an advanced state, 70% of the cases end up with the spread beyond the adrenal gland. After one year and three months of the diagnosis of the treatment in Albania and the United States, she wondered if she had the best decisions for treatment and her choosing for the healthcare organizations to take care of her illness. In addition to the reflecting opinions about her prognosis and treatment that had involved numerous organizations and individuals in both countries. Care Delivery Value Chain (CDVC) and Ms. Lushko The care delivery value chain begins with monitoring and prevention, and progresses through diagnosing, preparing, intervening, and recovery or rehabilitation, concluding with monitoring and managing. Each of these medical domains is supported by different services, such as records management, patient education, results measurement and organizational learning, among others. When preparing a (CDVC) we have to ensure that both sequential and parallel processes be designed and integrated to produce operational excellence and continually improved patient outcomes and results. This means that every step in the value chain must produce improved results at a lower cost. We have to use unique methodologies to make sure that individual medical, administrative, and patient support processes are designed and integrated in such a way that each contact with the patient produces a positive patient experience and outcome. Then these conditions are continually improved and financial results enhanced.

Care Delivery Value Chain (CDVC) and Integrated Practice Unit Optimal CDVC for this patient and other cancer patients

When we talk about the CDVC delivered to Ms.Lushko and the service provided to her in the previous weeks, we will find that there is a significant weakness in the healthcare plan presented. Starting from the admission of the patient when there was not an appointment plan depending on the patients medical condition, whether he can wait for long times. Like what Johnson medical center did with this lady. Based on what we learned in the previous classes the best way to save time in appointment setting strategy is the implementation of EMR (Electronic Medical Records) which will have a great effect on saving time for this patient, either in this hospital or the other hospital in Albania when they had to do another CT scan and MRI and will be also cost efficient on the patient. Another point is the proficiency and experience of the medical team that is responsible for this kind of diseases; when we talk about cancer we talk about highly corrosive malignant disease that each minute should be counted on the patients life. So the medical team must be consisted of trainer students and residents students, but at the same time they should be managed by a highly experienced or more consultants that they can refer to him in any case. Another point is concerning the results of lab diagnosis: I dont deny that some lab finding may take up to two weeks until they show up, but also there are many blood and urine tests can be done within minutes, in this case the urgent lab tests should be applied depending on the patients medical situation which will have a great positive effect on the patients health in prevention and early diagnosis of the disease. Not like what happened in this case, when the whole process of her treatment delayed, the disease and its malignancy cannot stop to metastasis. In the following diagram shows how we can apply measurement system for cancer patient: the first step is to identify the initial diagnosis, once the diagnosis identified then the

Care Delivery Value Chain (CDVC) and Integrated Practice Unit curative phase started, which include: radiation, chemotherapy, etc. before applying this phase,

we have to check again the patients health outcomes and compliance. Compliance will affect the indicators (cancer cell markers presence), and then we evaluate the health outcomes finally. If the outcome was not positive or favorable, then we have to change the healthcare plan provided.

Patient Compliance Potential Initial Condition Processes Indicators Health outcomes

Ideal Integrated Practice Unit and Ms. Lushiko The integrated practice unit should be organized around the patient, provides the full cycle of care for a medical condition, including patient education, engagement and follow-up. Encompasses inpatient, outpatient, and rehabilitative care as well as supporting services (e.g. nutrition, social work).Involves a dedicated team who devote a significant portion of their time to the medical condition, providers are part of a common organizational unit that is co-located in dedicated facilities. Utilizing a single administrative and scheduling structure is very important. A physician team captain and a care manager oversee each patients care process and the team meets formally and informally as a group and in subgroups on a regular basis, while Measures processes and outcomes as a team, not individually. The ideal integrated practice unit for Ms. Lushiko and many cancer patients may be the same, since most cancer patient would experience the same side effects of the radiation and chemotherapy. The integrated cancer care should be categorized into dedicated personnel, who will directly affect the patients disease and the shared personnel. The shared personnel, depend

Care Delivery Value Chain (CDVC) and Integrated Practice Unit and collaborate with the dedicated personnel in order to a get the best health outcome, as clarified in the following table. Dedicated MD Endocrinologist (for Ms.Lushiko) Surgical and Radiation oncologists Dentists (for Stomatitis which is one of the most side effect of chemotherapy) Pathologist (for the opportunistic infections that might happen) Ophthalmologist (if the tumor on the occipital area where vision verve is) Facilities Skilled Staff Registered Nurses Speech pathologists Facilities Patient access center and dedicated outpatient unit. Shared

MD Other specialist may be needed depend on the metastasis of the disease (cardiologists, plastic surgeons) Skilled Staff Dietician-inpatient nutritionistsRadiation nutritionists and smoking cessation counselors.

Inpatient wards, medical wards surgical wards, operation room

Care Delivery Value Chain (CDVC) and Integrated Practice Unit References Porter, M.,&Teisberg, E. (2006).Redefining Healthcare: Creating Value-Based Competition on Results. Boston, MA: Harvard Business School Press.

Porter, M.(2010). Value-based healthcare deliver: integrated practice units, and outcome and cost measurement. Harvard business school. Vol.4.