From Volume to Value: Transforming Health Care Payment and Delivery Systems to Improve Quality and Reduce Costs

Summarizes presentations on the changes in payment systems and organizational structures required to provide higher-quality health care, including episode-of-care payments for major acute episodes. Suggests pilot projects and implementation strategies

Cordaid-IICD Health Programme Uganda:Health Management Information Systems as a Tool for Organisational Development\ud

A Health Management Information System (HMIS) can be a powerful tool to make health care delivery more effective and far more efficient. This paper describes how an HMIS can also be used for organisational development and reports on the experiences of the HMIS programme of the Uganda Catholic Medical Bureau (UCMB) in Uganda. The programme forms part of a larger programme on ICTs for health in Uganda, Tanzania and Zambia and is supported jointly by the International Institute for Communication and Development (IICD) and the Catholic Organisation for Relief and Development Aid (Cordaid). The goal of the paper is to evaluate the project against a background of organisational development and to draw practical lessons from the project that may provide guidance to new HMIS projects in the development context.\u

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Call to Action for a System-wide Focus on Equity

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 5: "Call to Action for a System-wide Focus on Equity"These solutions create value not only for patients, but also for health care providers and public and private payers.  Each of these actors have a role to play in scaling and sustaining the health equity solutions.

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Public-Private Partnership, Contracting Arrangements and Managerial Capacity to Strengthen RCH Programme Implementation

Strengthening management capacity and meeting the need for Reproductive and Child Health (RCH) services is a major challenge for the national RCH programme in India. Central and state governments are working through multiple options to meet this challenge, responding to the complexity of issues in RCH which cut across social, cultural and economic factors, as well as reflecting the immense geographical barriers to access for remote and rural populations. Other barriers are also being addressed, including lessening financial burdens and creating Public - Private Partnerships (PPP) to expand access. For example, the NRHM has been initiated with particular focus on rural population. However, there are a number constraints faced by departments of health in implementing these initiatives. In this paper we focus on one key area: the development of management capacity for working with the private sector. A synthesis of the learning from three case studies of public-private partnerships in the RCH area is discussed. Two case studies pertain to state level initiatives in Gujarat and Andhra Pradesh and third study focuses on the national level mother NGO scheme. The objective of these case studies was to investigate how management capacity was developed through the implementation of these three public-private partnerships initiatives and contracting out of RCH services. The case studies also focused on the partnership in service delivery setting by examining the structure and process of partnership experiences, understanding the management capacity and competency in make-up of various public-private partnership initiatives in RCH, and identify pathways towards developing management capacity of partners to address key challenges in implementation.