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Running head: VALUE PROPOSITION IN PATIENT CARE

VALUE PROPOSITION IN PATIENT CARE

TOOBA SIDDIQUI

Strayer University

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Dr. Narrad Beharry

HSA 501: Management in Health Care

January 23, 2016

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VALUE PROPOSITION IN PATIENT CARE

Articulate the meaning of value-added service as it pertains to patient care services, and
argue the major reasons why it matters to add value to patient services. Justify your
response.
Responsible reform for the Middle Class stated, The Patient Protection and Affordable Care Act
will ensure that all Americans have excess to quality, affordable health care and will create the
transformation within the health care system necessary to contain costs. One part of the

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transformation is the creation of the value proposition. Value proposition is the promise of the
value to deliver to the patients with possible services. Value is defined as a fair return or

equivalent in goods, services and money for something exchanged; the monetary worth of

something; market price; or the relative worth, utility, or importance (Merriam-Webster 2010).
In healthcare, value is measured by the outcomes achieved, not the volume of services delivered
without the improved quality and nor measure by the process of care used.

Value can be seen a mathematical equation. Outcomes are the numerator of the value equation.
The outcomes are perceived as the real measures of quality. Outcomes measurement focuses on
the immediate results of the particular procedures or interventions, rather than the full care cycle
for medical condition or preventive care. Cost is the denominator. It refers to the total cost of the

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entire cycle of care for the patients medical condition. Best approach is to spend more money on
some services to decrease the need for others.

An example of why value added services matters to the healthcare system is because the value
should be about the patients, and no longer it should be about how many patients a physician can
see, how many tests and procedures a physician can order. Todays value-added services cover a
wide scope. They can be as simple as lifestyle management programs that encourage people to
participate in exercise protocols intended to help manage symptoms of RA, or as complex as

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VALUE PROPOSITION IN PATIENT CARE

hands-on, day-to-day management of hepatitis C patients so that they take their prescribed dose
of antiviral medications.
Although their working mechanisms may be very different, the promise of every proposed valueadded service is simple: improve patient outcomes and, consequently, save money. But the
primary question surrounding them remains as complex as ever: Which value-added services
truly add value and which are merely marketing?

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Most value-added services are centered around one of two concepts cost or convenience,
says Judi Grupp, president of ActiveCare Network, a provider of vaccine, injection, and infusion
services throughout the United States. When you have chronic patients you are trying to

manage over long periods of time, you want not only patient-reported data, which can be very
subjective, but also clinical data that show whether the drug is working like its supposed to.
Health plans ... dont mind covering a biologic if it does what it is supposed to do, but they need
data to help make that decision. More and more frequently, thats what were asked to provide.

Outline a system for identifying the functional areas in which changes might be necessary in
order to improve the hospitals service value. Recommend the key methods that you would use

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to acquire the information necessary to identify the specified functional areas.

Health care delivery involves numerous organizational units, ranging from hospitals to

physicians' practices to units providing single services, but none of these reflect the boundaries
within which value is truly created. The proper unit for measuring value should encompass all
services or activities that jointly determine success in meeting a set of patient needs. These needs
are determined by the patient's medical condition, defined as an interrelated set of medical

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VALUE PROPOSITION IN PATIENT CARE

circumstances that are best addressed in an integrated way. The definition of a medical condition
includes the most common associated conditions meaning that care for diabetes, for example,
must integrate care for conditions such as hypertension, renal disease, retinal disease, and
vascular disease and that value should be measured for everything included in that care.
For primary and preventive care, value should be measured for defined patient groups with
similar needs. Patient populations requiring different bundles of primary and preventive care

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services might include, for example, healthy children, healthy adults, and patients with a single
chronic disease, frail elderly people, and patients with multiple chronic conditions.

Care for a medical condition (or a patient population) usually involves multiple specialties and
numerous interventions. Value for the patient is created by providers' combined efforts over the
full cycle of care. The benefits of any one intervention for ultimate outcomes will depend on the
effectiveness of other interventions throughout the care cycle.

Accountability for value should be shared among the providers involved. Thus, rather than

focused factories concentrating on narrow groups of interventions, we need integrated practice

units that are accountable for the total care for a medical condition and its complications.

Because care activities are interdependent, value for patients is often revealed only over time and
is manifested in longer-term outcomes such as sustainable recovery, need for ongoing

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interventions, or occurrences of treatment-induced illnesses. The only way to accurately measure

value, then, is to track patient outcomes and costs longitudinally.

For patients with multiple medical conditions, value should be measured for each condition, with
the presence of the other conditions used for risk adjustment. This approach allows for relevant
comparisons among patients' results, including comparisons of providers' ability to care for
patients with complex conditions.

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VALUE PROPOSITION IN PATIENT CARE

Specify four (4) specific areas where you believe the administration can add value in Paradise
Hospital, and argue the most significant reasons why such value proposition would improve
the value of services to the patients.
The current organizational structure and information systems of health care delivery make it
challenging to measure (and deliver) value. Thus, most providers fail to do so. Providers tend to
measure only what they directly control in a particular intervention and what is easily measured,

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rather than what matters for outcomes. For example, current measures cover a single department (too
narrow to be relevant to patients) or outcomes for a whole hospital, such as infection rates (too broad
to be relevant to patients). Outcomes should include the health circumstances most relevant to

patients. They should cover both near-term and longer-term health, addressing a period long enough
to encompass the ultimate results of care. And outcome measurement should include sufficient
measurement of risk factors or initial conditions to allow for risk adjustment.

I believe that below mentioned four areas are important to be added as value-services in Paradise
Hospital and for the betterment of its patients too. Each of the area contains one or more distinct
outcome dimensions. For each dimension, success is measured with the use of one or more specific
metrics.

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Area 1 is the health status that is achieved or, for patients with some degenerative conditions,

retained. The first level, survival, is of overriding importance to most patients and can be measured
over various periods appropriate to the medical condition; for cancer, 1-year and 5-year survival are
common metrics. Maximizing the duration of survival may not be the most important outcome,
however, especially for older patients who may weight other outcomes more heavily.

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VALUE PROPOSITION IN PATIENT CARE

Area 2 is the degree of health or recovery achieved or retained at the peak or steady state, which
normally includes dimensions such as freedom from disease and relevant aspects of functional
status.
Area 3 is related to the recovery process. The first level is the time required to achieve recovery and
return to normal or best attainable function, which can be divided into the time needed to complete
various phases of care. Cycle time is a critical outcome for patients not a secondary process

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measure, as some believes. Delays in diagnosis or formulation of treatment plans can cause
unnecessary anxiety. Reducing the cycle time (e.g., time to reperfusion after myocardial infarction)
can improve functionality and reduce complications. The second level in Tier 2 is the disutility of
the care or treatment process in terms of discomfort, retreatment, short-term complications, and
errors and their consequences.

Area 4 is the sustainability of health. The first level is recurrences of the original disease or longerterm complications. The second level captures new health problems created as a consequence of
treatment. When recurrences or new illnesses occur, all outcomes must be re-measured.

Each medical condition (or population of primary care patients) will have its own outcome

measures. Measurement efforts should begin with at least one outcome dimension at each tier, and

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ideally one at each level. As experience and available data infrastructure grow, the number of
dimensions (and measures) can be expanded.

Improving one outcome dimension can benefit others. For example, more timely treatment can

improve recovery. However, measurement can also make explicit the tradeoffs among outcome
dimensions. For example, achieving more complete recovery may require more arduous treatment or
confer a higher risk of complications. Mapping these tradeoffs, and seeking ways to reduce them, is
an essential part of the care-innovation process.

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VALUE PROPOSITION IN PATIENT CARE

References

Michael E. Porter, December 23, 2010, What Is Value in Health Care?. Retrieved from:
http://www.nejm.org/doi/full/10.1056/NEJMp1011024?viewType=Print
Porter ME, Baron JF, Chacko JM, Tang RJ. The UCLA Medical Center: kidney transplantation.
Harvard Business School Case 711-410. Boston: Harvard Business School Publishing, 2010.

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http://www.hbs.edu/centennial/businesssummit/healthcare/value-based-health-care-delivery.html
Dipti Gupta, Ingolf Karst, Ellen B. Mendelson. (2016) Value-Based Reimbursement: Impact of
Curtailing Physician Autonomy in Medical Decision Making. American Journal of
Roentgenology 206, 276-279

Alison Tse Kawai, ScD;1 Michael S. Calderwood, MD, MPH;1,2 Robert Jin, MS;1 Stephen B.
Soumerai, ScD;1 Louise E. Vaz, MD, MPH;3 Donald Goldmann, MD;4,5 Grace M. Lee,
MD, MPH1,5, August 1, 2015, Impact of the Centers for Medicare and Medicaid

Services HospitalAcquired Conditions Policy on Billing Rates for 2 Targeted HealthcareAssociated Infections. Retrieved from:

http://eds.a.ebscohost.com.libdatab.strayer.edu/eds/pdfviewer/pdfviewer?sid=a7dd73f1b7e2-4de6-9fca-a322a0474ac6%40sessionmgr4001&vid=5&hid=4105

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JOHN POTT and JEANNA HOLTZ, March 1, 2014, The potential of value-added services in
health micro insurance. Retrieved from:

http://eds.a.ebscohost.com.libdatab.strayer.edu/eds/pdfviewer/pdfviewer?sid=67ba1ba46060-417e-90c8-3d8e99703405%40sessionmgr4001&vid=5&hid=4103

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