Week 9 Discussion Response- Delivery of Healthcare

Colleague 1

Kristina Rivera

This evaluation focuses on Boise, Idaho, addresses myocardial infarction as the identified heart disease health condition and compares the U.S. Healthcare delivery model to the Netherlands.

Value Based Care Model: Information Technology

In Boise, Idaho information technology (IT) plays an increasingly important role in supporting value-based care for patients with myocardial infarction (MI), though opportunities for further advancement remain. Within health systems, electronic health records and patient portals enable providers across primary care, cardiology, acute care and rehabilitation to access shared clinical data, review diagnostics, manage medications and communicate with patients throughout the continuum of care. For MI patients, this IT infrastructure supports timely referrals, coordination of diagnostic testing, mediation reconciliation, and post-discharge follow-up.

Value based care requires more than basic interoperability, and it depends on the ability to rack outcomes and cost across the fully cycle care. Research highlights that advanced IT systems capable of integrating outcome measures, real-time clinical data and population health analytics are essential to improving quality and reducing cost for complex health conditions. Harvard Business School Institute for Strategy and Competitiveness (n.d). stated, “Providers, IT vendors, policy makers, and payers will need to coordinate and integrate efforts to accelerate value-added deployment of IT in health care. IT is an essential tool to enable a VBHC system but is not itself a solution to low-value care. Government can have a major impact on stimulating health information technology innovation that will finally achieve the potential of enabling significant improvement of value for patients.” By expanding IT capabilities beyond documentation toward outcomes measurement and analytics, Boise’s healthcare system could leverage information technology to support value-based, patient-centered care.

IOM Aim of Be Equitable

In Boise, Idaho, achieving the Institute of Medicine (IOM) aims to be equitable in the care of patients with myocardial infarction (MI) requires addressing disparities related to geography, socioeconomic status, age and access to preventive and specialty care. While Boise benefits from advanced cardiac services within integrated health systems, equity challenges persist for rural residents, lower-income populations, older adults, and individuals with limited health literacy or transportation access. These factors can influence timely access to diagnostics, interventions cardiology, cardiac rehabilitation and long-term secondary prevention, ultimately affecting outcomes for MI patients.

In Boise, patients with consistent primary care access and employer-sponsored insurance are more likely to benefit from early detection of cardiovascular risk factors and coordinated post-MI follow up, whereas underserved population may experience delays in care or lower participation in cardiac rehabilitation programs. Heslip (n.d). stated, “policy process should be standardized and hardwired so that, at any point in time, the correct procedure is provided to a surveyor or attorney upon request. Patients should be able to come to any hospital and receive the same evidence-based care. That is dependent on the policies, procedures and other documents caregivers rely on to deliver their care. Addressing equity for MI care in Boise requires targeted outreach, expanded telehealth and transportation support, culturally appropriate education, and proactive referral to community resources to ensure all patients can benefit equally from evidence-based cardiac care.

Healthcare Country Comparison Aligning Information Technology

A country outside of United States whole healthcare delivery model closely aligns with the value-based care element of information technology is the Netherlands. The Dutch healthcare system has made significant investments in interoperable health information technology to support coordination, quality measuring and value-based care delivery. Nationwide initiatives promote the use of shared electronic health records, standardized data exchange, and secure health information networks that allow primary care providers, hospitals, specialists, pharmacies and rehabilitation services to access and share data across the full continuum of care.

In the Netherlands, health IT is deliberately designed to support outcomes-based care rather than isolated encounters. Continuous improvements in information technology enable the availability of outcomes data across the care spectrum. This is essential for monitoring performance, reducing duplication, and improving coordination. Mjaset, et.al. (2020) stated, “Understanding of these strengths and weaknesses can yield insights for policymakers and providers as they strive for a more patient-focused, value-based care delivery environment. Government involvement can facilitate change by setting the right conditions (e.g., for regional system integration). Continuous IT improvements to ensure the availability of outcome data across the full care cycle and instituting a value-based culture among providers are keys to driving VBHC implementation. General practitioners use electronic systems that integrate hospital summaries, diagnostic results and medication data. Additionally, patients have direct access to their records through patient portals. This further supports clinical decision making, enhances continuity and reinforces a value-based culture among providers. The Dutch model demonstrates how robust, interoperable information technology can serve as a foundational enabler of value-based care by linking providers, patients and outcomes across the healthcare system.

References:

Harvard Business School Institute for Strategy & Competitiveness. (n.d.). Information technologyLinks to an external site.Links to an external site.. https://www.isc.hbs.edu/health-care/value-based-health-care/key-concepts/Pages/information-technology.aspxLinks to an external site.

Heslip, N. (n.d.). Crossing the quality chasmLinks to an external site.Links to an external site.. PolicyMedical. https://assets.hcca-info.org/Portals/0/PDFs/Resources/library/Crossing%20the%20Quality%20Chasm.pdf

Mjåset, C., Ikram, U., Nagra, N. S, & Feeley, T. W. (2020, November 10). Value-based health care in four different health care systemsLinks to an external site.Links to an external site.. NEJM Catalyst, 1(6), 1–23. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0530

Colleague 2

Gisselle Meza

Hello class,

My healthcare community is in Denver, Colorado. The health problem identified is cancer (malignant neoplasms), and Canada is the comparison country. In Denver, health care leaders, policymakers, and informatics stakeholders must recommend developing a strong information infrastructure to support cancer care delivery, quality improvement, community accountability, and clinical education. This infrastructure must focus on automating patient-specific clinical data and removing most handwritten clinical data. According to the Institute of Medicine, this commitment can result in the removal of the vast majority of handwritten clinical data by the end of the decade (2001). This type of investment is critical to an effective, patient-centered, timely, efficient, and equitable health system.

To be equitable, Denver should introduce multilingual patient portals and online navigation tools that enable effective communication between patients and providers throughout the cancer care continuum. The platforms will facilitate fair, patient-centered care by enhancing access, engagement, and coordination (Harvard Business School, n.d.). Canada has a coordinated, highly interoperable digital health infrastructure compared to Denver's fragmented health IT landscape, enabling data transfer and continuity of care across providers (El Sabawy et al., 2024). This model highlights the importance of interoperability and shared responsibility, which Denver can learn to enhance coordination, efficiency, and equity in the delivery of cancer care (El Sabawy et al., 2024). 

References

El Sabawy, D., Feldman, J., & Pinto, A. D. (2024). The Connected Care for Canadians Act: an important step toward interoperability of health data. CMAJ, 196(42), E1385-E1388. https://doi.org/10.1503/cmaj.241123Links to an external site.

Harvard Business School. (n.d.). Information Technology. https://www.isc.hbs.edu/health-care/value-based-health-care/key-concepts/Pages/information-technology.aspxLinks to an external site.

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press.  DOI: 10.17226/10027.