Task: Patient-Centred Healthcare
Time: 1 Hour
Learning outcome: 'I understand the patient pathway and know of tools I can use to support it'
Remember to record this activity in your BPV Specialist learning activity log
* denotes optional background reading links
READING: ‘Redefining Global Healthcare Delivery’ by Jim Yong Kim, Paul Farmer and Michael Porter via The Lancet
The first value principle is that of ‘patient-centred’ care and designing and offering services based around patient and population need. We’ll explore how to do that in future learning tasks that detail the WHAT element of the BPV Decision Framework and other tools.
For now, we’ll concentrate on the patient pathway and examine some of the tools that you can use to maximise value for service users and taxpayers.
The Patient Pathway
Porter has taken the original ‘value chain’ that applies to most businesses, and redefined the ‘Care Delivery Value Chain’ (CDVC). For a condition (for example, diabetes or maternity), this model groups the interactions a patient may have during the course of their care into a series of process headings: from monitoring and prevention, through diagnosis and interventions, to monitoring and managing.
Each of these interactions are usually carried out by a different provider. In a very simple example, cancer may be:
We currently put a lot of focus on interventions. But would paying more attention earlier in the pathway be better for the patient, and save the NHS taxpayer money? (Tip: this is value thinking!)
This short animation illustrates an NHS RightCare example of applying the principles of the patient pathway to a diabetes example:
The patient pathway is the driving force behind other tools and techniques such as Patient-Level Information Costing Systems (PLICS) and Time-Driven Activity-Based Costing (TDABC) which we’ll examine in future learning tasks as well.
The Patient Population
We’ve now got into the habit of thinking about:
How can we design services to meet patient need?
How can we use the full patient pathway to maximise value?
We also need to then start asking:
How can we apply the same value principles for individuals to a whole population of people?
Lee, Farmer and Porter use HIV/AIDS as an example to demonstrate that a relatively small spend on screening an at-risk population at the preventing stage (for example, counselling on modes of transmission) will likely forestall disease progression and save the need for far more costly therapies at the intervention stage (for example, anti-retroviral therapy).
This approach to value creation prioritises improving the quality of life for the patient, and reducing overall cost to healthcare is a fortuitous by-product.
Reproducing this process for other condition or disease pathways is argued to provide a scalable model that can be replicated across a system to the financial benefit of all actors.
You’ll already be aware of NHS RightCare’s ‘Atlases of Variation’ which compare patient outcomes for whole populations of citizens.
“The NHS Atlas series is pivotal in the interrogation of routinely available data that relate investment, activity and outcome to the whole population in need and not just those who happen to make contact with a particular service. Only by taking this population perspective can we trigger the search for unwarranted variation and assess the value of the healthcare provided both to populations and to individuals.”
In learning task 4 in two weeks’ time the subject will be patient outcomes.
READING: ‘Contracting for Outcomes – A Value-Based Approach’ via Capsticks
I hope you've found this learning task useful. Please feel free to contact me with any feedback or post questions by replying to this thread.