4.5 Chapter Summary

The Population Health Management (PHM) pathway has transitioned healthcare from a disease-only treatment model for individuals to a management model that requires clinical effectiveness, cost-effectiveness, and safer health outcomes. The latest version of our national public health objectives, Healthy People (HP) 2030, lists 355 core objectives ranging from reducing chronic diseases to mitigating contagious diseases. However, it was a seminal article that introduced one of the most important PHM components – the Triple Aim. The three pillars of the Triple Aim include improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare. Many people face barriers that prevent or limit access to needed healthcare services, which may increase the risk of poor health outcomes and health disparities. Barriers that prevent or limit access include lack of health insurance, poor access to transportation, and limited healthcare resources. Sometimes people don’t get recommended health care services, like cancer screenings, because they don’t have a primary care provider or live too far away from health care providers who offer them. Further research is needed to better understand the barriers to primary care and develop interventions that expand access.  Health literacy, or the ability to find, understand, and use information and services to inform health-related decisions and actions, is another barrier to accessing healthcare. It results from both individual capacities (i.e., personal health literacy) and the complex demands of the U.S. healthcare system (i.e., organizational health literacy).

Healthcare quality is care that is safe, effective, patient-centered, timely, efficient, and equitable. Four widely utilized improvement methodologies to improve processes and healthcare quality include Plan-Do-Study-Act, Six Sigma, Lean, and Lean Six Sigma. The cycle of PDSA allows for refinement of the change to implementation on a broader scale after successful changes have been identified. Six Sigma uses a measurement-based strategy for process improvement and problem reduction applied to improvement projects. The core principle of Lean is to reduce and eliminate non-value-adding activities and waste. The combination, Lean Six Sigma, has resulted in superior results to what either program could have achieved alone. Quality measures in healthcare include the Magnet Recognition Program, value-based reimbursement models, CMS quality initiatives, the accreditation review process, core measures, and patient safety goals.

The United States (U.S.) spends more per capita on healthcare than any comparable high-income country. Although other comparable countries spend much less on healthcare than the U.S., health outcomes in these countries are as good or even better than outcomes in the U.S. The national trends affecting the cost of healthcare in the U.S. include the aging population, medical technology costs, prescription medication costs, Patient Protection and Affordable Care Act, and social determinants of health.

Key terms included in this chapter are also listed in the Glossary at the end of the book.

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Exploring the U.S. Healthcare System Copyright © 2023 by Karen Valaitis is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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