1 / 12

The healthcare purchaser as a care chain orchestrator

This research explores the role of healthcare purchasers in improving population health and delivering better chronic care. It analyzes the influence of healthcare system characteristics on purchaser strategies and actions, as well as the impact of stakeholder pressures on institutional logics. The study also discusses how purchasing can contribute to care chain orchestration and provides recommendations for policymakers and purchasers.

barbarab
Download Presentation

The healthcare purchaser as a care chain orchestrator

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The healthcare purchaser as a care chain orchestrator Healthcare market limitations and opportunities Bart Noort, Kees Ahaus, Taco van der Vaart University of Groningen, department of Operations

  2. Healthcare purchasing Healthcare purchasing needs to become strategically aimed at improving population health (Klasa, 2018, Figueras, 2005) But this is often not the case (Klasa, 2018; Klein, 2015; Maarse, 2016; Porter, 2016) We know: the tools and rules that may support purchasers • Financing schemes • Quality measures • Provider competition (Klasa, 2018; Thomson, 2013; Van de Ven, 2013)

  3. Healthcare purchasing We don’tknow: Why purchasers develop certain strategies, behaviour, logics and: • How thisfollowsfrom health policy and regulation • And from the pressuresfrom stakeholders

  4. Thesis structureand research questions How do healthcare system characteristicsinfluence a purchaser’sstrategiesand actions? How do stakeholder pressures affect thepurchaser’sinstitutional logics? How canhealthcarepurchasingcontributetobetterchronic care delivery? Health system & policy How healthcare system characteristics affect purchasing (Chapter 2) Chronic care chain management What drives healthcarepurchaser’sinstitutionallogics? (Chapter 3) Healthcare purchasing Health, quality & costs The consequences of healthcarepurchasing on improving care delivery (Chapter 4 & 5)

  5. Study 1: How healthcare system characteristics affect purchaser’sstrategiesand actions A multiple case studycomparing a region in England, Sweden andthe Netherlands Case: How do purchaserspursueimprovedtaskdivision and collaborationbetweenGPs and hospitals delivering COPD care? Case selection: Data sources: 1. Interviews withpurchaser managers, medical professionals and provider managers (22 interviews, 26 persons) 2. Managerial documentation on purchaser’svision, plansandevaluation of initiatives (39 documents) Bart Noort, Kees Ahaus, Taco van der Vaart, Naomi Chambers, RodSheaff. How healthcare systems shape a purchaser’s strategies and actions when managing chronic care. R&R Health Policy

  6. Resultsstudy 1: How healthcare system characteristics affect purchaser’sstrategiesand actions

  7. Conclusionsstudy 1: How healthcare system characteristics affect purchaser’sstrategiesand actions Purchasercompetition, purchasergovernanceandpatientchoice are key in explainingpurchaserstrategiesand actions • High competition drives a short-term strategy, focusing on costs in stead of the care chain, patientand prevention • Clinicalgovernance benefits purchaser-provider relationshipsand drives support toprovider • Patientchoicelimitsthepurchaser’sabilitytopursueitsimprovement agenda

  8. Study 2: How stakeholder pressures drive purchaser’sinstitutionallogics Longitudinal case study on purchaser- provider collaborationtoimprove COPD care Multiple initiatives for improvement: • ‘Proeftuin’ (Vanguard) initiative • Home coaching project, diagnostic pathways project • Intention to change incentives (shared savings) May 2015-present: observations (~10 meetings), interviews (25) 1 insurer, 4 hospitals, multiple primary care providers Research questions: Can we explain the purchaser’s approach by distinguishing different institutional logics? What pressures originating from the different involved stakeholders can explain the emergence of different logics?

  9. Resultsstudy 2: How stakeholder pressures drive purchaser’sinstitutionallogics

  10. Conclusionsstudy 2: How stakeholder pressures drive purchaser’sinstitutionallogics Uncertainty Emergence of theorchestrator’s logic andfalling back intothebookkeeper’s logic explained: Proposition 1 Changing intensity of one pressure influences how the purchaser deals with other pressures Proposition 2 The purchaser’s internal organization determines how the purchaser deals with pressures Providers Subscribers Relational Costpressures Purchaserinstitutionallogics Public health demands Medicaldemands Stakeholders Government Pressures

  11. Study 3 (chapters 4 & 5). A health and economic impact analysis on COPD coaching

  12. Discussionandconclusions How healthcarepurchasingcanbecome care chain orchestration Governmentsshouldcreatethe right policy context: • The right incentives (not only for providers) • A good power balance between purchasers and providers Purchasersshouldcreatethe right internalorganization: • Sufficient (medical) knowledge • Capacityto support, conduct data-analysis, buildrelationships

More Related