Model Healthcare Delivery System: Design & Components

Introduction to Healthcare Delivery Systems

The healthcare delivery system — also referred to as the HCDS — is the most effective system for most healthcare organizations in all countries, enabling fair, effective, and efficient distribution of resources. It is a fast-growing service that demands attention from various quarters and domains. At the optimal level, the service program presents relief and hope to individuals and the general population. The system offers a balanced, quality care service through efficiency and fairness. HCDS varies across the world, but its focus is constantly on enhancing healthcare access, quality of service, and coverage. The success of the program depends on the availability of certain basic resources (Kumar & Bano, 2017, p. 1).

HCDS represents how society has responded to health determinants. The idea of a healthcare system involves the people likely to be served by such a system, as well as agencies and organizations that offer products and services to meet the healthcare goals and health needs of the population under focus (Mills, 2014, p. 553). The central aim of HCDS is to hold human life in high esteem and to enhance health at the individual, community, and societal level (Starfield & Macinko, 2005, p. 500). The efficiency of a healthcare system is determined by materials, human resources, finance, and the availability of safe healthcare options (Nishtar, 2006, p. 5).

The nature of a balanced healthcare system is such that individuals are provided with a continuum of healthcare promotion, diagnosis, disease prevention, treatment and management, life-course support, and palliative care through various sites and levels of care in the system — all tailored to their needs across their lives (Hirshon et al., 2013, p. 387). Any healthcare system should aim at fostering easy access to healthcare by making it affordable and patient-centered, with an emphasis on quality service provision. Healthcare systems should be designed in a way that motivates both care providers and patients alike, with all decisions aligned to achieving that objective (AAFP, 2018).

Measuring Care Quality

It is extremely important to measure and report on the quality of healthcare. Such practice enables employers and consumers alike to choose and decide — based on factual determinants — what care is suitable for them. However, assessment of healthcare goes beyond simply informing consumers about their choices. Feedback to health plans is a central component of the whole process. Such feedback can be used by stakeholders to improve areas of need. There are several methods of assessing healthcare quality. Intermittent site surveys, satisfaction surveys, audits, and clinical performance checks can all be applied for this purpose (NCQA, n.d.).

Electronic medical records (EMRs) are essential in facilitating the exchange of information and encouraging higher levels of patient engagement. If EMRs are to be used optimally and to facilitate patient-centered communication, it is imperative to exercise due care in their use. There are mixed findings regarding the attitudes of physicians and other healthcare providers toward EMR use. It is important to evaluate patient perceptions of EMR use by providers and the healthcare quality ratings associated with it, as a strategic way of understanding the workings and effectiveness of EMRs. A sample of adults from across the USA was examined to check whether EMR use, as reported by patients, has a connection with care quality ratings (Rutten et al., 2014, p. 17).

Health policy formulators have long been considering the design of technologies that enable healthcare in order to solve a myriad of healthcare issues (Haux et al., 2008, p. 78). Technology is seen as one of the channels for introducing change into the healthcare system, and information technology (IT) is equally significant in this respect. ICT gives users access to user-friendly health information online (Cramer, 2009, p. 13). The integration of technology and healthcare has generated health-enabling technologies; ICT can help resolve many health challenges (Gauld, 2005, p. 103). It is also critical to the delivery of healthcare (Chassin & Galvin, 1998, p. 1004) and for guaranteeing the provision of safe care (Bates, 2001, p. 301). Both current and future healthcare services rely heavily on e-Health (Novillo-Ortiz, 2010, p. 227).

Designing a Model System

Adhering to long-held traditions in medicine — in the context of quality and cost — has given the field a literature rich with examples of successful models that lack underlying theories or principles. Ideally, this means there is a good reason for developing a model from the outset, one based on the elements of theory found in models that have already succeeded. Apart from weaving in long-term sustainability, there is a rare and unique opportunity to build a shared vision among stakeholders — something that would have been far more difficult to achieve during more stable times (Kepros & Opreanu, 2009).

Providers need to look for innovative care models that can reduce costs and deliver results, and it should be recognized that health plans offer comparable benefits. The Commonwealth Fund, in March 2012, shared performance findings on healthcare systems, using 43 indicators to evaluate US health communities across four dimensions: prevention, treatment, access, and healthcare outcomes. The results confirmed what has long been known — that where people live affects how easily they can access healthcare. The survey revealed differences in health outcomes, costs, and quality based on geographic location (Wren, 2012).

The unique factors that influence health outcomes in each community are helping to drive innovation now visible in various system models. The Affordable Care Act, health systems, clinics, physicians, private payers, and hospitals have all been seeking ways to offer better care, better population health, and reduced costs. This quest has produced several innovative initiatives in the private sector, including collaborative delivery model systems based on payer-provider partnerships, shared stakeholder investment, and extended care networks (Wren, 2012).

Conclusion

Performance gaps that are in the public domain must begin to be closed by providers, even as the urgency for healthcare reform gains momentum. Successful models that will be in use in the future will possess certain common characteristics. They will be anchored in multidisciplinary healthcare teams oriented toward a common set of objectives. They will communicate directly with one another and cooperate on decision-making regarding priority issues. The physician will be leveraged by emphasizing the incorporation of associate providers into key pivotal functions that link the team to a wider population. The provider may also act as coordinator between teams and settings.

Although technology will be viewed as an important enabler — for standardizing the capture of clinical outcomes, ensuring that information is widely distributed and available, and maintaining compliance with safety and other requisite protocols — it will not be used as a substitute for human interaction among members of the healthcare team. Providers that attain notably high performance levels in primary competencies will gain an advantage that helps them in higher-risk environments (Cook, 2010, p. 5).

It is paramount for the healthcare system to devise ways to deploy and administer interdisciplinary patient-centered healthcare teams. It must figure out how to facilitate timely information flow and how to link such teams to the priorities and resources of the parent organization. Challenges span from planning how tasks can be accomplished to identifying who will carry them out. An organizational chart is one option that can help clarify the course of action; when a structure exists, it offers a clear direction in situations of confusion arising from overlapping functions and closely interrelated, subtly distinct setups (Cowen et al., 2008, p. 417).

It takes considerable effort to convert broad goals into concrete tasks. The health system must determine how patient-focused interdisciplinary care teams can be created — teams that provide timely information to patients and connect them with relevant resources and healthcare services. This is not an individual effort; it is a team effort. As discussed above regarding CPTs, the most important challenge is not simply completing these tasks, but ensuring they are carried out by the right people. Much more can be accomplished by making use of data-driven approaches for designing and testing innovative ideas for health improvement.