PA 574: Health Systems Organization Session 1 – March 30, 2011

 Definition  Properties  Components

 Network of inter-related components  Coherence and integration among parts  Standardized  Coordinated  Common support structures

 Includes all the activities whose primary purpose is to promote, restore or maintain health  Formal health services, traditional services, public health, alternatives  Health systems:  Improve health of populations  Respond to people’s expectations  Provide financial protection against costs of ill health

 Financing  To obtain health services  Insurance  Protection against risks  Delivery  Providers of services  Payment  Reimbursement Shi & Singh, Figure 1-1, p. 6

 Education & Research  Suppliers  Insurers  Providers  Payers  Government Shi & Singh, Table 1-1, p. 3

Illness Wellness Specialized care Primary care Inpatient Ambulatory Technological Humanistic Cost unaware Cost accountable Institution based Community-based Individual patient Population focus Professional Managerial Curative care Preventive care Individual provider Provider teams Independent orgs. Integrated systems Service duplication Service continuum Current regulation Re-regulation Market commodity Public good

 Social values and cultures  Population characteristics  Political climate  Economic conditions  Physical environment  Technology development  Global influences Shi & Singh, Figure 1-2, p. 10

1. No central governance 2. Access based on insurance 3. Imperfect market conditions 4. Third-party insurers act as intermediaries 5. Multiple payers make system cumbersome 6. Balance of power prevents dominant single entity 7. Legal risks affect practice 8. New technology creates demand 9. Continuum of new service settings 10. Quality and value

 Goals:  Improving the experience of care  Improving the health of populations  Reducing per capita costs of health care  Preconditions:  “Enrollment” of population  Commitment to universality  Role of “integrator”

 Partner with individuals/families  Redesign of primary care  Population health management  Financial Management  System integration at macro level

 Six Aims  Safe  Effective  Patient-centered  Timely  Efficient  Equitable  Ten rules for redesign of system  (next week)

 Positioning organization  Pursuing organizational mission  Managing threats/opportunities  Evaluating implications  Planning  Seeking new markets  Complying with regulations

 Descriptive - what is  Analytic - ways to investigate  Explanatory - understand why  Evaluative - assess what is  Speculative - question what if  Prescriptive - fix what should be  Administrative - manage best  Transformative - improve/change

 Seven Criteria  Effectiveness  Efficiency/cost- effectiveness  Quality  Accessibility  Equity  Satisfaction  System-ness Adapted from Dan Harris and Greg Lee  Six Aims  Safe  Effective  Patient-centered  Timely  Efficient  Equitable IOM

 Readings for this week and next week  Skim text, read articles in more depth  Systems Project groups  Announced next week  Race Against Time groups  Meet briefly now