This book offers a comprehensive overview of performing return-on-investment (ROI) analyses for healthcare quality improvement (QI). In the United States, healthcare policy regarding physician and facility payment/reimbursement is steadily trending towards the use of “value-based” systems and away from the traditional “fee-for-service” (FFS) payment mechanisms. Healthcare professionals and organizations who have previously focused on quality metrics are now finding themselves burdened with having to define and assess value metrics, without much guidance or assistance. This volume aims to be a guide and a reference for healthcare professionals tasked with estimating and establishing ROI for QI. Chapters describe the general framework for how to perform QI; establish standard definitions of important terms, concepts, and calculations; and provide specific instructions for how to complete each step of an ROI analysis. These include: selecting a QI initiative and identifying the associated metrics, establishing measurable, monetizable, and attributable costs and benefits, determining the appropriate scope and perspective, calculating ROI and related metrics (payback period, benefit-to-cost ratio, etc.), comparing with established benchmarks or previously published results, and interpreting the results for the intended audience. In addition, chapters offer examples of real studies (or hypothetical studies of real situations), as well as templates for several of the necessary activities that readers can leverage for their own use. Return on Investment for Healthcare Quality Improvement is a must-have resource for healthcare providers, administrators, and other professionals who work in healthcare organizations, hospitals and other healthcare settings, health systems, and residency programs seeking to obtain outside funding, as well as policy makers and administrators of federal programs.

Agile Implementation describes the underlying theories and frameworks that explain health delivery systems and lays out the 8 steps of the Agile Implementation Model founded by Malaz Boustani, MD, MPH and Jose Azar, MD. In today’s complex healthcare environment, implementing evidence-based care into real-world practices is difficult and time consuming. Even methods that are known to be effective allow for limited flexibility and therefore fail as often as they succeed. Through much study and experimentation, Malaz Boustani, MD, MPH, Jose Azar, MD, and Craig A. Solid, PhD have come to understand how individuals’ interactions within the complex social systems of hospitals, clinics, and other care delivery organizations shape the decisions and behaviors of those involved. Upon this foundation and through leveraging theories of behavioral economics, we have developed the Agile Implementation Model, a process for selecting, adapting, implementing, evaluating, sustaining, and scaling evidence-based healthcare interventions. This model acknowledges the uniqueness of each individual facility and considers individuals within the system to be semiautonomous but interconnected. In tandem with illustrative examples, Agile Implementation describes the underlying theories and frameworks that explain health delivery systems and lays out the 8 steps of the Agile Implementation Model. Upon completing Agile Implementation, readers have a better understanding of why certain quality initiatives succeed while others fail and have tangible, actionable tools for implementing effective and sustainable change in the healthcare setting.

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The National Roundtable on Health Care Quality was established in 1995 by the Institute of Medicine. The Roundtable consists of experts formally appointed through procedures of the National Research Council (NRC) who represent both public and private-sector perspectives and appropriate areas of substantive expertise (not organizations). From the public sector, heads of appropriate Federal agencies serve. It offers a unique, nonadversarial environment to explore ongoing rapid changes in the medical marketplace and the implications of these changes for the quality of health and health care in this nation. The Roundtable has a liaison panel focused on quality of care in managed care organizations. The Roundtable convenes nationally prominent representatives of the private and public sector (regional, state and federal), academia, patients, and the health media to analyze unfolding issues concerning quality, to hold workshops and commission papers on significant topics, and when appropriate, to produce periodic statements for the nation on quality of care matters. By providing a structured opportunity for regular communication and interaction, the Roundtable fosters candid discussion among individuals who represent various sides of a given issue.

These days, the idea of “value” is at the center of many activities and decisions in health care in the United States. While there exist books that detail the technical steps for how to carry out a specific type of value assessment, such as cost-effectiveness or return on investment, there are few that attempt to teach healthcare professionals how to think about value. This book provides a deeper understanding of value as a concept as well as an endeavor (as in, to determine or uncover the value of care) within the healthcare industry by illustrating the different components of value that should guide decision-making processes for policy, infrastructure, and quality improvement. Through an exploration of theories of economics and implementation science, as well as practical suggestions for real-world applications, this text provides a foundation for the long and complicated “value” journey the US has bet its entire healthcare system on. In the US, policy to promote what is referred to as “value-based care” is here to stay. As we move forward within this construct, we need to move beyond the over-simplified definition of value as “quality per dollar spent” to a more functional framework for how to think about value that can adapt to different circumstances and points of view. Only then will it be possible to compare value across settings, conditions, and activities. The book consists of 9 chapters organized in four sections: Part I: Understanding the Challenges of Assessing the Value of Health Care Part II: A Primer on Fundamental Concepts and Current Techniques Used to Measure Value in Health Care Part III: A Discussion of the Real-world Motivations and Requirements that Should be Contemplated when Exploring Value Part IV: How to Design and Perform a Value Assessment Practical Strategies to Assess Value in Health Care is an essential resource for healthcare professionals at all levels and points of care who are interested in understanding how best to assess and interpret value for a particular situation including providers, administrators, payers, insurers, health plans, and policy-makers.

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.