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1 – 10 of over 43000At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public…
Abstract
At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.
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Martin McShane and Karen Kirkham
Changes in demographics and disease patterns are challenging health and care systems across the world. In England, national policies have reset the direction of travel for the…
Abstract
Purpose
Changes in demographics and disease patterns are challenging health and care systems across the world. In England, national policies have reset the direction of travel for the NHS. Collaboration, integration and personalisation are intended to become prime principles and drivers for new models of care. Central to this is the concept of population health management. This has emerged, internationally, as a method to improve population health. Fundamental for population health management to succeed is the use of integrated data, analytics combined with professional insight and the adoption of a learning health system culture. This agenda reaches beyond the NHS in England and the public health profession to embrace a broad range of stakeholders. By drawing on international experience and early experience of implementation in the United Kingdom, the potential for health and care systems in England to become world leading in population health management is explored.
Design/methodology/approach
A viewpoint paper.
Findings
Population health management is a major change in the way health and care systems look at the challenges they are facing. It makes what is happening to individuals, across the continuum of care, the essence for insight and action. The NHS has the components for success and the potential to become world leading in delivery of population health management as part of its integrated care agenda.
Originality/value
This is the first viewpoint paper to set out how population health management contributes to the integrated care agenda in the NHS.
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Cynthia J. Sieck, Thomas Wickizer and Laurel Geist
Individuals suffering from serious mental illness (SMI) face many challenges of navigating a complex and often fragmented health care system and may die significantly earlier from…
Abstract
Purpose
Individuals suffering from serious mental illness (SMI) face many challenges of navigating a complex and often fragmented health care system and may die significantly earlier from co-morbid physical health conditions. Integrating mental and physical health care for individuals with SMI is an emerging trend addressing the often-neglected physical health care needs of this population to better coordinate care and improve health outcomes.
Design/methodology/approach
Population Health Management (PHM) provides a useful framework for designing integrated care programs for individuals with SMI.
Findings
This paper examines the structure and evolution of the integrated care program in Missouri in the context of PHM, highlighting particular elements of PHM that facilitate and support development of an integrated mental and physical health care program.
Originality/value
As health care reform provides external motivation to provide integrated care, this study can be useful as other states attempt to address this important issue.
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Meghan Hufstader Gabriel, Danielle Atkins, Xinliang Liu and Rebecca Tregerman
The purpose of this paper is to investigate the relationship between ownership type and population health initiatives adopted by hospitals using the 2015 American Hospital…
Abstract
Purpose
The purpose of this paper is to investigate the relationship between ownership type and population health initiatives adopted by hospitals using the 2015 American Hospital Association data.
Design/methodology/approach
Hospitals of various sizes, ownership structures and geographic locations are represented in the survey. The outcome variables of interest include measures of hospital population health activities.
Findings
Findings indicate that nonprofit hospitals are most likely to express commitment to population health and participate in population health activities, with for-profit hospitals being least likely. Implications for policy and practice are discussed.
Research limitations/implications
This study demonstrates that discrepancies in population health approaches exist across ownership status – particularly, nonprofit hospitals appear to be the most likely to be involved in population health efforts.
Practical implications
As we continue to push for population health management in the hospital setting, grappling with the definition and purpose of population health management will be essential.
Social implications
Overall, these results suggest that nonprofit hospitals are more likely to be implementing population health efforts than for-profit or government-owned hospitals.
Originality/value
Although there are several studies on population health in hospitals, this study is the first to investigate the relationship between ownership type and population health initiatives adopted by hospitals.
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Helmut Hildebrandt, Timo Schulte and Brigitte Stunder
The purpose of this article is to share emerging evidence about the qualitative and economic benefits of integrating care, based on an innovative population‐based approach across…
Abstract
Purpose
The purpose of this article is to share emerging evidence about the qualitative and economic benefits of integrating care, based on an innovative population‐based approach across a small region of Germany. The article aims to discuss the features that have similarities to the international discussion around managed care and accountable care, e.g. the use of a “gain share” model to incentivise all the main partners, and the quite unique approaches derived from a public health background. The operation of Gesundes Kinzigtal could be considered as a benchmark for the “Clinical commissioning groups” that are in development as a result of the Health and Social Care Act 2012 in the UK.
Design/methodology/approach
A regional health management company in cooperation with the physicians' network in the region and two health insurance providers has reorganized the delivery of care across all sectors towards improving the health of the population. The key features of the approach are summarised in the paper. Administrative and medical data obtained from the health insurance providers and from routine management monitoring are used to evaluate the benefits of the approach compared to control groups.
Findings
The project is beginning to demonstrate that this model of integrated care can be effective, with cost benefits and savings for the partners, and improved health outcomes for the population.
Research limitations/implications
The project started in 2006, and only early results of the first three to four years are reported here because of the use of claims data of health insurers.
Originality/value
The approach is an innovative model of integration in its combination of logistical re‐engineering of care processes, IT integration, public health and prevention measures. Its evaluation through an ambitious series of studies may have long‐term relevance for the organisation and management of care services internationally.
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Constance Dumalanede, Kavita Hamza and Marielle Payaud
This study aims to highlight the processes that private organisations implement to improve access to health care services for low-income communities in Brazil.
Abstract
Purpose
This study aims to highlight the processes that private organisations implement to improve access to health care services for low-income communities in Brazil.
Design/methodology/approach
A qualitative research based on a comparative case study was conducted in São Paulo. A for-profit organisation and a not-for-profit one were compared to scrutinise how they adapt themselves to the social context they are embedded in; while improving their service accessibility.
Findings
Both kinds of organisations have succeeded to reach their goal of improving the access and reducing the time frame of health care services to low-income populations. Their initial business model (BM) makes them face their own challenges that they face with different strategies. It affects their way of communicating, their organisational culture, the patients’ expectations and their level of inclusiveness.
Research limitations/implications
The research is context-dependent because of the specific conditions of the health public system in Brazil. When shaping health care BMs, the national context must be taken into account and the service marketing components should be used to enhance patients’ value co-creation in the health care service delivery process.
Practical implications
The research gives insights to organisations that seek to adapt their BM to improve health-care access to low-income populations.
Social implications
Health-care access plays a key role in improving populations’ living conditions and reach one of the sustainable development goals of the United Nation.
Originality/value
Health care services access at the bottom of the pyramid remains under-studied. The paper brings value by comparing for-profit and non-profit organisations, which have the same social goal of improving health-care access to low-income populations while developing different practices to deal with their own challenges.
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Richard Q. Lewis and Nav Chana
The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the delivery of…
Abstract
Purpose
The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the delivery of the goals of “population health”. The authors examine evidence from earlier initiatives to achieve similar objectives of primary care-led health system planning and care integration to understand relevant lessons for the PCH.
Design/methodology/approach
This paper is based on a descriptive review of the PCH using documentary sources and a non-systematic review of literature relating to primary care commissioning initiatives and recent initiatives to deliver general practice services on a larger scale.
Findings
The PCH is likely to bring forth relatively high engagement from general practitioners due to its neighbourhood scale, voluntary nature and its focus on professional partnership, personalisation of care and outcomes. It is important that participants have sufficient autonomy to act and that financial incentives are aligned with the goals of population health. It is also important that, unlike some earlier primary care initiatives, the PCH is given time to develop to maturity.
Originality/value
The PCH is a recent phenomenon that is developing in England and elsewhere. This paper locates the PCH within a historical context and draws conclusions from a relevant evidence base.
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Recent invasions, coups, civil wars, and ethnic crusades have caused many individuals and families around the world to flee their homelands for fear of their own safety. The…
Abstract
Recent invasions, coups, civil wars, and ethnic crusades have caused many individuals and families around the world to flee their homelands for fear of their own safety. The exodus of refugees to foreign nations causes a strain on those nations’ health care systems and resources. With the assistance of outside organizations, these countries can develop a health care management system for refugees that provides for both their immediate survival and long-term health stability, while preserving critical national resources. This chapter reviews the refugee problem and presents the short-term tactics and long-term strategies undertaken by seven very different national governments to care for the refugees that cross their borders. A model of a sound health care management system is used to incorporate the best practices of each country into a framework for approaching this multi-billion dollar issue.
Rosemarie Santa González, Marilène Cherkesly, Teodor Gabriel Crainic and Marie-Eve Rancourt
This study aims to deepen the understanding of the challenges and implications entailed by deploying mobile clinics in conflict zones to reach populations affected by violence and…
Abstract
Purpose
This study aims to deepen the understanding of the challenges and implications entailed by deploying mobile clinics in conflict zones to reach populations affected by violence and cut off from health-care services.
Design/methodology/approach
This research combines an integrated literature review and an instrumental case study. The literature review comprises two targeted reviews to provide insights: one on conflict zones and one on mobile clinics. The case study describes the process and challenges faced throughout a mobile clinic deployment during and after the Iraq War. The data was gathered using mixed methods over a two-year period (2017–2018).
Findings
Armed conflicts directly impact the populations’ health and access to health care. Mobile clinic deployments are often used and recommended to provide health-care access to vulnerable populations cut off from health-care services. However, there is a dearth of peer-reviewed literature documenting decision support tools for mobile clinic deployments.
Originality/value
This study highlights the gaps in the literature and provides direction for future research to support the development of valuable insights and decision support tools for practitioners.
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