Geography of Care

Today’s top health care providers can help lead the way
toward a nationwide value-based health care delivery
system that dramatically improves outcomes and controls
health care costs. By expanding strategically and integrating
with community providers, those already renowned for
innovation and excellence and patient care can widen
access, improve treatments, and help reduce fragmentation
and geographic “gaps” in services.
In a high-value health care system, medical condition-specific IPUs need to
expand geographically, rather than continuing to compete only locally or
regionally. Value will increase quickly when superior providers serve more
patients through strategic expansion, rather than through the purchase of full-
service hospitals.

Traditional geographic expansion has been focused on acquiring health care

facilities that merely reproduce the same services in the different areas without
regard to value. In these expansions, care remained organized around traditional
medical specialties and every site performed every procedure in an aim to
provide a full set of services in every location. While that strategy was effective
when hospitals had little to offer, the ever increasing complexity of medical care
today means that every hospital should not be performing highly complex
procedures or treating exceeding complex patients. Not every hospital needs a
heart transplant program, or even cardiac surgery, yet that is what has happened
in US health care expansion today.

Rational geographic expansion should occur through a hub-and-spoke model of

satellite centers or through clinical affiliations with existing providers. Several
premier organizations have already begun this geographic expansion. The
Cleveland Clinic expanded but the main center in Cleveland served as the hub
with its condition based IPUs. As they expanded their affiliate program, they did
so in areas of their IPU expertise like cardiac care and care of end stage renal
disease. They maintained Cleveland Clinic quality care through education and
careful measurement.
Another system that expanded geographically through affiliation agreements is
the Vanderbilt Health Affiliated Network (VHAN). With their main facility in
Nashville as their hub, they expanded their care network over a 9 state area
through affiliations.

The University of Texas MD Anderson Cancer Center geographically expanded

initially through an MD Anderson Cancer Network that included certified member
community affiliate sites who were evaluated on a regular basis with respect to
concordance with MD Anderson clinical care guidelines for different cancer
conditions. These tended to be relatively small medical oncology practices. They
then expanded further by affiliating with large partner institutions who could
provide IPU based comprehensive cancer care. Partnering with Banner Health
Care in Arizona, Cooper University Health Care in New Jersey, Baptist Health in
Jacksonville, UT Health in Tyler and San Antonio, and Scripps Health in San
Diego, MD Anderson affiliated with established care delivery systems to provide
their cancer care using the MD Anderson IPU model and credentialing of
affiliated physicians at the geographic expansion site.

The major risk of geographic expansion is damage to the reputation of the main
center if care at distant sites does not result in similar outcomes as the main
center. Without rigorous outcome measurement, those assurances cannot be
made to the organization or the public.

Geografi Perawatan
Penyedia perawatan kesehatan terbaik saat ini dapat
membantu memimpin jalan menuju sistem pemberian
perawatan kesehatan berbasis nilai nasional yang secara
dramatis meningkatkan hasil dan
mengontrol biaya perawatan kesehatan . Dengan
berkembang secara strategis dan berintegrasi dengan
penyedia komunitas, mereka yang sudah terkenal akan
inovasi dan keunggulannya serta perawatan pasien dapat
memperluas akses, meningkatkan perawatan, dan
membantu mengurangi fragmentasi dan “celah” geografis
dalam layanan.
Dalam sistem perawatan kesehatan yang bernilai tinggi, IPU khusus kondisi
medis perlu berkembang secara geografis, daripada terus bersaing hanya
secara lokal atau regional. Nilai akan meningkat dengan cepat ketika penyedia
yang unggul melayani lebih banyak pasien melalui perluasan strategis, daripada
melalui pembelian rumah sakit dengan layanan lengkap.

Perluasan geografis tradisional difokuskan pada perolehan fasilitas perawatan

kesehatan yang hanya mereproduksi layanan yang sama di wilayah yang
berbeda tanpa memperhatikan nilai. Dalam perluasan ini, perawatan tetap diatur
seputar spesialisasi medis tradisional dan setiap situs melakukan setiap
prosedur dengan tujuan untuk menyediakan layanan lengkap di setiap
lokasi. Sementara strategi itu efektif ketika rumah sakit hanya memiliki sedikit
tawaran, kompleksitas perawatan medis yang semakin meningkat saat ini berarti
bahwa setiap rumah sakit tidak boleh melakukan prosedur yang sangat
kompleks atau merawat pasien yang melebihi kompleks. Tidak setiap rumah
sakit membutuhkan program transplantasi jantung, atau bahkan operasi jantung,
namun itulah yang terjadi dalam perluasan perawatan kesehatan AS saat ini.

Perluasan geografis yang rasional harus terjadi melalui model hub-and-spoke

pusat satelit atau melalui afiliasi klinis dengan penyedia yang ada. Beberapa
organisasi utama telah memulai perluasan geografis ini. Klinik Cleveland
berkembang tetapi pusat utama di Cleveland berfungsi sebagai pusat dengan
IPU berbasis kondisinya. Saat mereka memperluas program afiliasi, mereka
melakukannya di bidang keahlian IPU mereka seperti perawatan jantung dan
perawatan penyakit ginjal tahap akhir. Mereka mempertahankan kualitas
perawatan Klinik Cleveland melalui pendidikan dan pengukuran yang cermat.

Sistem lain yang berkembang secara geografis melalui perjanjian afiliasi adalah
Vanderbilt Health Affiliated Network (VHAN). Dengan fasilitas utama mereka di
Nashville sebagai pusatnya, mereka memperluas jaringan perawatan mereka di
9 wilayah negara bagian melalui afiliasi.

Pusat Kanker MD Anderson Universitas Texas secara geografis berkembang

secara geografis pada awalnya melalui Jaringan Kanker MD Anderson yang
mencakup situs afiliasi komunitas anggota bersertifikat yang dievaluasi secara
teratur sehubungan dengan kesesuaian dengan pedoman perawatan klinis MD
Anderson untuk berbagai kondisi kanker. Praktik onkologi medis ini cenderung
relatif kecil. Mereka kemudian berkembang lebih jauh dengan berafiliasi dengan
lembaga mitra besar yang dapat menyediakan perawatan kanker komprehensif
berbasis IPU. Bermitra dengan Banner Health Care di Arizona, Cooper
University Health Care di New Jersey, Baptist Health di Jacksonville, UT Health
di Tyler dan San Antonio, dan Scripps Health di San Diego, MD Anderson
berafiliasi dengan sistem pemberian perawatan yang mapan untuk memberikan
perawatan kanker mereka menggunakan model MD Anderson IPU dan
kredensial dokter yang berafiliasi di lokasi perluasan geografis.

Risiko utama perluasan geografis adalah kerusakan reputasi pusat utama jika
perawatan di lokasi yang jauh tidak menghasilkan hasil