Search

Health care organizations can magnify the impact of their community service and other philanthropic activities by implementing programs that create shared value. By definition, shared value is created when an initiative generates benefit for the sponsoring organization while also generating societal and community benefit. Because the programs generate benefit for the sponsoring organizations, the magnitude of any particular initiative is limited only by the market for the benefit and not the resources that are available for philanthropy. In this article we use three initiatives in sectors other than health care to illustrate the concept of shared value. We also present examples of five types of shared value programs that are sponsored by health care organizations: telehealth, worksite health promotion, school-based health centers, green and healthy housing, and clean and green health services. On the basis of the innovativeness of health care organizations that have already implemented programs that create shared value, we conclude that the opportunities for all health care organizations to create positive impact for individuals and communities through similar programs is large, and the limits have yet to be defined. [ABSTRACT FROM AUTHOR]

Context: Primary care practice. Objective: To test whether the principles of complex adaptive systems are applicable to implementation of team-based primary care. Design: We used complex adaptive system principles to implement team-based care in a private, five-clinic primary care practice. We compared randomly selected samples of patients with coronary heart disease (CHD) and diabetes before system implementation (March 1, 2009, to February 28, 2010) and after system implementation (December 1, 2011, to March 31, 2013). Main Outcome Measures: Rates of patients meeting the composite goals for CHD (blood pressure < 140/90 mmHg, low-density lipoprotein cholesterol level < 100 mg/dL, tobacco-free, and using aspirin unless contraindicated) and diabetes (CHD goal plus hemoglobin A1c concentration < 8%) before and after the intervention. We also measured provider and patient satisfaction with preventive services. Results: The proportion of patients with CHD who met the composite goal increased from 40.3% to 59.9% (p < 0.0001) because documented aspirin use increased (65.2%-97.5%, p < 0.0001) and attainment of the cholesterol goal increased (77.0%-83.9%, p = 0.0041). The proportion of diabetic patients meeting the composite goal rose from 24.5% to 45.4% (p < 0.0001) because aspirin use increased (58.6%-97.6%, p < 0.0001). Increased percentages of patients meeting the CHD and diabetes composite goals were not significantly different (p = 0.2319). Provider satisfaction with preventive services delivery increased significantly (p = 0.0017). Patient satisfaction improved but not significantly. Conclusion: Principles of complex adaptive systems can be used to implement team-based care systems for patients with CHD and possibly diabetic patients. [ABSTRACT FROM AUTHOR]

To overcome system failures, health care organizations must implement a few simple rules of complex adaptive systems. I describe Transition in Care, Kaiser Permanente Southern California's program to reduce hospital readmissions, as an example of a program design that meets the principles of complex adaptive systems and enumerate five rules, which must be followed if a health system is to create value for their stakeholders. [ABSTRACT FROM AUTHOR]

The author reflects on a paper exploring the relative frequency of publications on comparative health systems research about Kaiser Permanente (KP) and other integrated delivery systems. He points out the minimal number of articles found and its impact on the delivery of health services, as well as the value Americans obtain from such care. He underscores the need for collaboration between the health care research and practice communities in intensifying comparative health systems research.

Context: A decision-support tool was created to identify opportunities to improve outcomes for patients with coronary artery disease and heart failure by delivering all efficacious interventions; that is, "optimizing" care. When national data were applied, nearly 75% of the deaths that could be prevented or postponed by optimizing care for patients with heart disease would occur among ambulatory patients., Objective: The purpose of this analysis is two-fold: 1) to determine whether medical group data are adequate to use in the decision-support tool, and 2) to determine whether the conclusions generated from the medical group data are similar to the conclusions generated from US data. DESIGN/MAIN OUTCOME MEASURE: The potential impact of optimizing care for patients age 40 to 75 years treated for coronary artery disease and heart failure by a multispecialty group between August 2007 and July 2008 was calculated using deaths that might be prevented or postponed if optimal care was achieved., Results: The greatest opportunity to prevent or postpone deaths-70% of the total opportunity-lies with optimizing care for ambulatory patients. Optimizing care for patients hospitalized for acute myocardial infarction with or without ST-segment elevation on electrocardiography would prevent or postpone only 2% of deaths., Conclusions: This study demonstrates that 1) it is feasible to use the decision-support tool to analyze opportunities for improvement in a medical group, and 2) as concluded from national data analysis, optimizing ambulatory care presents the greatest opportunity to improve outcomes for patients with heart disease.