Information Knowledge Systems Management - Volume 8, issue 1-4

Authors: Shortell, Stephen M. | McCurdy, Rodney K.

Article Type: Research Article

Abstract: Before meaningful gains in improving the value of health care in the US can be achieved, the fragmented nature in which health care is financed and delivered must be addressed. One type of healthcare organization, the Integrated Delivery System (IDS), is poised to play a pivotal role in reform efforts. What are these systems? What is the current evidence regarding their performance? What are the current barriers to their establishment and how can these barriers be …removed? This chapter addresses these important questions. Although there are many types of IDS' in the US healthcare landscape, the chapter begins by identifying the necessary healthcare components that encompass an IDS and discusses the levels of integration that are important to improving health care quality and value. Next, it explores the recent evidence regarding IDS performance which, while generally positive, is less than what it could be if there were greater focus on clinical integration. To highlight, the chapter discusses the efficacy of system engineering initiatives in two examples of large, fully integrated systems: Kaiser-Permanente and the Veterans Health Administration. The evidence here is strong that the impact of system engineering methods is enhanced through the integration of processes, goals and outcomes. Reforms necessary to encourage the development of IDS' include: 1) the development of payment mechanisms designed to increase greater inter-dependency of hospitals and physicians; 2) the modification or removal of several regulatory barriers to greater clinical integration; and 3) the establishment of a more robust data collection and reporting system to increase transparency and accountability. The chapter concludes with a framework for considering these reforms across strategic, structural, cultural, and technical dimensions. Show more

DOI: 10.3233/IKS-2009-0147

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 369-382, 2009

Authors: Sanfilippo, Fred

Article Type: Research Article

Abstract: Academic Health Centers (AHCs) are comprised of academic, hospital, and clinical practice components that play a key role in healthcare delivery by their special ability to identify and implement improvements in outcomes, safety, cost-benefit, and satisfaction. They do this by utilizing a wide range of academic and clinical health professionals and disciplines to provide cutting-edge, highly specialized patient care as well as disproportionate uncompensated care in communities nationwide; to identify the effectiveness of …different diagnostic and therapeutic approaches through clinical research; to foster new discoveries in biomedical science and technology and their clinical application; and to educate future generations of health professionals who apply these improvements. As the traditional homes of innovation in health and healing through research, and as the major sites of implementing change through education, AHCs have been at the forefront of improving healthcare. To successfully improve the effectiveness and efficiency of healthcare delivery, it is critical that AHCs continue to serve as uniquely integrated models for improving quality and value through novel approaches in education, research, and service. Show more

DOI: 10.3233/IKS-2009-0149

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 383-414, 2009

Authors: Perlin, Jonathan B. | Baggett, Kelvin A.

Article Type: Research Article

Abstract: All levels of government have an economic and social interest in health. In the United States, Federal, state and local government are involved in the development of health policy, funding health care, and maintaining or improving public health. Federal, State and most municipalities also engage in delivery of health services. As with the private sector, government is grappling with accelerating health care costs, increasing service demands generated by an aging and more chronically ill society, and …accumulating evidence that American health outcomes are not commensurate with the resources invested. Unlike the private sector, attempts to improve value in health care – whether through legislation in Congress or regulation or program design in the Executive branch – are subject to the full intensity of the partisan political process. In order to engage effectively with government in health system transformation, an understanding of both the civic processes and the political dynamics is necessary. This chapter provides an overview of the major governmental roles in health care as formally structured and identifies points of influence in the political process. Show more

DOI: 10.3233/IKS-2009-0148

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 415-434, 2009

Authors: Saxton, Jonathan F. | Johns, Michael M. E.

Article Type: Research Article

Abstract: Significant reform of the health care system sufficient to achieve universal coverage, a value-driven system and administrative simplification faces enormous barriers at the level of our societal ecosystem – barriers as large as any that can be faced in public policy. These barriers exist within the health system itself as a complex adaptive system, and are structured by our economic, legal, cultural and political systems. Because there are so many barriers, significant reform is a relatively …rare occurrence. Yet it does happen and there are some important examples of major health care reforms. There are a number of lessons to be learned from the successful enactment of the Medicare and Medicaid programs that appear relevant to current and future reform efforts. First, a necessary condition for achieving significant reform is the existence of large and sufficiently enduring social forces sufficient to disrupt legislative and policy stasis and drive the necessary political solutions. Second, public sentiment and electoral "mandates" might be necessary to significant reform, but they are not sufficient. Third, assuming the theoretical capacity to manage the constellation of systemic, economic, legal, cultural and legislative barriers, there remains a political "tipping point" that must be crossed and translated into a Congressional super-majority in order to enact significant nationwide reform. Show more

DOI: 10.3233/IKS-2009-0150

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 437-463, 2009

Authors: Cortese, Denis A. | Rouse, William B.

Article Type: Research Article

Abstract: This chapter addresses the prospects for change in health care delivery. The focus is on value – high quality, affordable care for everyone. We consider three domains that participate in the flow of value and the nature of the interfaces among these domains. We also discuss strategic priorities that should align in various ways with these domains. Finally, we address the business transformations needed to enable the provision of value by enterprises that are viable and …successful. Show more

DOI: 10.3233/IKS-2009-0151

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 465-477, 2009

Article Type: Other

DOI: 10.3233/IKS-2009-0154

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 479-480, 2009