HLTH 6510 Week 11 Health System Outcomes Paper Example

How the Region's Arrangements Produce Its Outcomes: Financing, Delivery and Population Health in One Explanation

Student Name

Walden University

HLTH 6510: Essentials of the U.S. Healthcare Delivery System and Population Health

Instructor Name

Month Day, Year

How the Region's Arrangements Produce Its Outcomes: Financing, Delivery and Population Health in One Explanation

The Outcome to Be Explained

In the course's rural county, premature death runs above the state figure, and an estimated 13% have diagnosed diabetes, with complications such as amputations and kidney failure appearing more often than in the urban county next door. This paper explains how the arrangements described across the term, how care is financed, how it is delivered and who delivers it, combine to produce that outcome. It does not survey the term's topics one by one. It traces a chain from arrangements to outcomes, using adults with diabetes as the thread, and ends with what the chain implies for changing those outcomes. The explanation is only as strong as its weakest link, so each link is stated with the evidence from earlier weeks that supports it. Population health, in the sense used here, concerns both a group's outcomes and the factors that produce them (Kindig & Stoddart, 2003).

Financing Shapes Who Can Use Care

The rural county's working adults are covered mostly through small employers offering high-deductible plans, through Medicaid or not at all. Employer coverage ties the first dollars of care to the worker's own pocket, as the week eight trace of a single March visit showed. For a person with diabetes, who needs regular visits, laboratory tests and medications, that design discourages exactly the routine care that prevents complications. Medicaid removes most direct costs but not the indirect ones, and its lower payment rates contribute to some physicians limiting new Medicaid patients, a pattern documented nationally (Decker, 2012). Financing thus sorts the county's adults into groups with different access to routine care before any clinic is involved.

Delivery and Workforce Shape Where and How Care Happens

Even with coverage, care in the rural county depends on a thin workforce and a delivery system whose weakest points are transitions. Its primary care supply per resident is well under half its neighbor's, and specialists barely live there at all. Patients with diabetes are referred 50 miles for endocrinology or wound care, wait weeks for new appointments and return to clinicians who may not receive the specialist's notes. Patient-centered access depends on both the availability of services and people's ability to reach them (Levesque et al., 2013), and both fail at the same points: distance, waits and information that does not travel with the patient.

Measurement Shapes What Gets Attention

The quality measures that plans and payers use reward a handful of diabetes processes and lab results among enrolled members. Those measures direct effort to valuable care, and the community health center has improved its scores. But they do not count transitions, patient experience or the uninsured, and they can push toward overtreatment in older patients (Pogach & Aron, 2011). The arrangements that measure care therefore strengthen attention to some links in the chain while leaving the weakest ones, the transitions, unmeasured and unrewarded.

Population Conditions Set the Starting Point

The county's adults start from higher need. The population profile showed an older, lower-income group with more smoking and less physical activity than the state as a whole, and parts of the county have limited access to healthy food. These conditions raise the prevalence of diabetes and the difficulty of managing it, whatever the health system does. A health system that delivers the same care to a higher-need population will produce worse outcomes; one that delivers less care to it, as the county's arrangements do, will widen the gap further.

A Patient Through the Chain

Consider one composite patient: a 56-year-old woman in the rural county who works at a small grocery and is covered by its high-deductible plan. She notices numbness in her feet but delays a visit because she has not met her deductible. When she goes, the community health center confirms worsening diabetes and refers her to a podiatrist and an endocrinologist in the urban county, with waits of three and six weeks. She misses the first appointment because she cannot take an unpaid day. Her clinic's quality score counts her A1c, which is high, but nothing records the missed referral. Four months later, a foot ulcer brings her to the critical access hospital, which transfers her to the regional medical center for surgery. Every link in the chain touched her care, and none alone caused the outcome. Had her plan exempted diabetes visits from the deductible, had the specialists been closer or had someone tracked the missed referral, the ulcer might have been caught early.

The Chain Assembled

Assembled, the chain runs as follows. Population conditions create higher need for diabetes care. Financing arrangements, high deductibles and lower Medicaid rates, reduce routine use and limit which providers accept patients. A thin workforce and fragmented delivery make the care that is sought harder to reach and less continuous. Quality measures reward the parts of care that are counted while the transitions where patients are lost go unmeasured. Each link alone would leave a gap; together, they produce more advanced disease when patients finally reach care, more complications and higher premature death. The comparison with Germany in week nine showed that different design answers, a mandate, income-based contributions, low capped cost sharing, can remove some links; the U.S. arrangements in the county leave them in place.

What the Explanation Implies

Because the chain has several links, no single change will close the gap, but each link suggests a lever. Plan design could exempt diabetes visits and tests from deductibles. The region could recruit to the shortage area through loan repayment and extend specialist reach through telehealth. The community health center and regional medical center could share records and agree on follow-up after hospital discharge. Payers could add measures for transitions and patient-reported outcomes. The triple aim framework treats the experience of care, the health of populations and per capita cost as goals to be pursued jointly (Berwick et al., 2008); the chain shows that in the rural county, those three already move as one.

References

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759

Decker, S. L. (2012). In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help. Health Affairs, 31(8), 1673-1679. https://doi.org/10.1377/hlthaff.2012.0294

Kindig, D., & Stoddart, G. (2003). What is population health? American Journal of Public Health, 93(3), 380-383. https://doi.org/10.2105/AJPH.93.3.380

Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, Article 18. https://doi.org/10.1186/1475-9276-12-18

Pogach, L., & Aron, D. C. (2011). Sudden acceleration of diabetes quality measures. JAMA, 305(7), 709-710. https://doi.org/10.1001/jama.2011.153