Evolving Health Care Delivery System Research Articles

A Re-evaluation of Global Financial Outlooks and Prospects in the Telehealth Industry Amidst the Transition to a Post-Pandemic Era

The onset of the COVID-19 pandemic propelled the telehealth sector into a period of rapid expansion, with web-based care emerging as a crucial tool for ensuring the safety of patients and healthcare providers alike. However, with the introduction of vaccines, the perceived need for telehealth services appeared to diminish, leading to a decline in value for telehealth companies. This shift prompted both existing players and newcomers in the telehealth space to innovate and redefine their value propositions in order to regain investor and customer confidence and stand out amidst increasing competition. The struggle to reshape the perception of telehealth from a pandemic-era necessity to a valuable complement to traditional in-person care has been reflected in the volatility of stock prices and declining valuations. This dynamic has underscored the need for telehealth companies to differentiate themselves through technological advancements and the convenience they offer. Analyzing the market through qualitative secondary research, incorporating insights from contemporary sources, financial data from platforms like Yahoo! Finance, and peer-reviewed literature, it becomes evident that the telehealth market experienced a surge in 2020, reaching $17.9 billion in the US alone, and is projected to grow to $140.7 billion by 2030. This growth was accompanied by a nearly twofold increase in digital health venture funding, reaching $14.1 billion in total funding. However, this rapid expansion led to an oversaturation of the market, with supply outpacing demand, resulting in a significant drop in valuations as vaccination rates rose in 2021. In response to this rebalancing, telehealth companies must chart a course for the post-pandemic era. The current role of suppliers in the telehealth space, whether they are established healthcare industry incumbents or innovative "telehealth-first" challengers, will influence the growth strategies they pursue. Moreover, identifying medical specialties and patient demographics that are best suited for web-based care will be critical for long-term success in the evolving healthcare delivery system. Looking ahead, investors should anticipate a bullish market characterized by growing share prices. Success in the telehealth industry is likely to hinge on fundamentally transforming care delivery models rather than simply transitioning traditional care to a web-based format. As the market consolidates, established telehealth giants capable of adapting to the changing landscape are expected to thrive, albeit amidst continued growth at a slower pace.

Expecting the Unexpected: How Regulators Can Prepare for Serious Events

Expecting the Unexpected: How Regulators Can Prepare for Serious Events

The role of oral health in an evolving health care delivery system: An interview with Bruce Donoff, D.M.D., M.D.

This interview is focused on the role that dentistry, and oral health more broadly, can play in improving the quality, accessibility, and value of health care delivered in the United States. The interview touches on the importance of oral health, transitioning from interprofessional education to interprofessional practice, and the opportunity for dental professionals to participate in value-based reimbursement models, among other related topics.

Let's Get Real About Health Care Reform.

In light of the ongoing debate about health care policy in the United States, including efforts to repeal and replace the Affordable Care Act, it will be critically important for the academic community to engage in the dialogue. Developing a viable approach to health care reform requires an understanding of the interaction and interdependence between choice, cost, and coverage in a competitive and functional market-based system. Some institutions have implemented models that indicate the feasibility of providing high-quality, efficient patient care while working within fixed budgets. The academic community must stay engaged in these conversations because of its moral commitment to equitable access to health care for all. Academic medical centers will also have to define and protect their roles in an evolving health care delivery system in the United States.

Diffusion of Mobile Health Apps Among Smartphone Users : Role of Neighborhood Effects, Informational Network Effects, and Social Ties in Health 3.0

The convergence of mobile technology with an evolving healthcare delivery system has ushered a wave of disruptive innovations that has bought a paradigm shift in healthcare delivery services; known as Health 3.0. If Health 1.0 was about content (portals, sites like WebMD), and Health 2.0 was focused around communities that capitalize on the knowledge gained by specific patients and their physicians (a diabetes message board), then Health 3.0 is about coherence of health information and active participation from users itself. Digital natives (DNs) are users born after 1980, grown up with digital devices and who are developing N-fluence networks (Topscott, 2008) via the Internet, especially through social media. This study proposed a conceptual model that deals with the diffusion of mobile health apps (mHealth apps) among digital natives (consumer reviews) and the role played by neighborhood effects, social network effects, and opinion leadership in such diffusion.

Identifying and Prioritizing Diseases Important for Detection in Adult Hearing Health Care

The purpose of this research note is to identify and prioritize diseases important for detection in adult hearing health care delivery systems. Through literature review and expert consultation, the authors identified 195 diseases likely to occur in adults complaining of hearing loss. Five neurotologists rated the importance of disease on 3 dimensions related to the necessity of detection prior to adult hearing aid fitting. Ratings of adverse health consequences, diagnostic difficulty, and presence of nonotologic symptoms associated with these diseases resulted in the identification of 104 diseases potentially important for detection prior to adult hearing aid fitting. Current and evolving health care delivery systems, including direct-to-consumer sales, involve inconsistent means of disease detection vigilance prior to device fitting. The first steps in determining the safety of these different delivery methods are to identify and prioritize which diseases present the greatest risk for poor health outcomes and, thus, should be detected in hearing health care delivery systems. Here the authors have developed a novel multidimensional rating system to rank disease importance. The rankings can be used to evaluate the effectiveness of alternative detection methods and to inform public health policy. The authors are currently using this information to validate a consumer questionnaire designed to accurately identify when pre- fitting medical evaluations should be required for hearing aid patients.

Accelerating design and transforming baccalaureate nursing education to foster a culture of health

Healthcare reform and changing population health demographics call for a radical transformation in healthcare delivery and the education of healthcare providers. Nurses comprise the largest proportion of healthcare providers making it necessary to ensure that they are prepared to address the challenges that arise from the evolving healthcare delivery system. A key message of the Institute of Medicine’s The Future of Nursing: Leading Change, Advancing Health , is that nurses must lead healthcare change. To accomplish this, nurses must recognize their role in educating the new nursing workforce about creating a culture of health. Specifically, nurse educators must act as stewards for promoting health and wellness, and reducing health disparities and inequities. They must also recognize their role in forming partnerships with community organizations to improve primary care and population health by addressing social determinants of health. The purpose of this paper is to describe the structure for developing an innovative baccalaureate nursing curriculum and lessons learned that can inform the efforts of others interested in accelerating design of new curriculum.

Will the RN Workforce Weather the Retirement of the Baby Boomers?

After forecasts made more than a decade ago suggested dire nursing shortages, enrollment in nursing schools doubled. The implications of this unprecedented change for the nursing workforce have not yet been fully explored. To forecast the size and age distribution of the nursing workforce to the year 2030 and to compare to demand recently projected by the Health Resources and Services Agency. A retrospective cohort analysis of employment trends by birth year and age were used to project age and employment of registered nurses (RNs) through 2030. Data on employed RNs from the United States Bureau of the Census Current Population Survey (1979-2000, N=72,222) and American Community Survey (2001-2013, N=342,712). RNs between the ages of 23 and 69 years. Annual full-time equivalent (FTE) employment of RNs in total and by single year of age. Annual retirements from the nursing workforce will accelerate from 20,000 a decade ago to near 80,000 in the next decade as baby boomer RNs continue to age. We project that this outflow will be more than offset by continued strong entry of new RNs into the workforce. Overall, we project that the registered nursing workforce will increase from roughly 2.7 million FTE RNs in 2013 to 3.3 million in 2030. We also find that the workforce will reach its peak average age in 2015 at 44.4. This increase in workforce size, which was not expected in forecasts made a decade ago, is contingent on new entry into nursing continuing at its current rate. Even then, supply would still fall short of demand as recently projected by the Health Resources and Services Agency in the year 2025 by 128,000 RNs (4%). The unexpected surge of entry of new RNs into the workforce will lead to continued net growth of the nursing workforce, both in absolute FTE and FTE per capita. While this growth may not be sufficient to meet demand, such projections are uncertain in the face of a rapidly evolving health care delivery system.

Accountable care organizations 101

This Issue Brief is the first in a series that the American Pharmacists Association (APhA) is producing to help inform members of the evolving health care delivery system, in particular a predominant new delivery model—the accountable care organization (ACO). ACOs provide the profession of pharmacy the opportunity to ensure that optimization of every patient's medication therapy is a core element of our future health care system. For more information go to APhA's MTM Central at www.pharmacist.com.

Using Grey Literature to Prepare Pharmacy Students for an Evolving Healthcare Delivery System

To assess the impact of using "grey literature" (information internally produced in print or electronic format by agencies such as hospitals, government, businesses, etc) rather than a textbook in a course on healthcare delivery systems on students' perception of the relevance of healthcare delivery system topics and their ability to identify credible sources of this information. A reading from the grey literature was identified and assigned to the students for each topic in the course. Pre- and post-course survey instruments were used for the assessment. Students reported healthcare delivery systems topics to be moderately relevant to the profession of pharmacy on both the pre- and post-course survey instruments. Students' knowledge of current and credible sources of information on healthcare delivery system topics significantly improved based on self-reports and scores on objective assessments (p<0.05). Assignment of grey literature in a course on healthcare delivery systems can be used to ensure that information in the pharmacy school curriculum is the most current and credible information available.

The Future of Health Social Work

The practice of social work in health care is at a critical juncture, and faces an uncertain future. The authors provide an overview of the challenges facing social work practice within the health care setting, as well as recommendations for enhancing social work practice and education. Challenges discussed include economic factors, demographic changes, and technological advances influencing the practice of social work in health care. The need for a proactive stance among social work professionals and educators is promoted. The proposed changes are intended to stimulate discussion and an exchange of ideas needed to maintain Social Work's relevance and integrity in the evolving health care delivery system.

Performance expectations of the associate degree nurse graduate within the first six months.

The Oklahoma Associate Degree Nursing Directors Council was determined to be proactive in defining the role of the associate degree registered nurse (ADN) within the evolving health care delivery system. A task force was formed by the Council to design and implement strategies for defining the emerging roles. Strategies included surveying health care employers on the performance expectations of the ADN graduates within the first six months of employment. The employers were asked to determine the importance of various functions and abilities that the ADN graduates may or may not possess. Surveys returned were representative of a variety of rural and urban agencies throughout the state and bordering areas. Responses were grouped into 21 categories. Ranked highest was the ability to demonstrate verbal and written communication effectively with accountability to the employer and personal attributes such as open-mindedness, flexibility, and receptiveness to criticism ranked second and third. The lowest rankings received were for competency with fiscal management. The results of the survey highlight the continued need to stress strong communication skills, as well as professional accountability throughout the educational process.

Making organizational change to achieve improvement and interprofessional learning: perspectives from health professions educators

Health professionals must learn to work in the context of an interdisciplinary team in order to meet the needs of the evolving health care delivery system. These teams must work successfully with community systems to achieve common goals, while understanding and respecting diverse perspectives, experiences and skills. Strategies for changing health professions education to prepare new health professionals for such work have been tested by the Interdisciplinary Professional Education Collaborative. Illustrations of making educational change, and creating situations to sustain the change, are offered from the Collaborative's experience. Teams participating in the Collaborative engaged in interprofessional education, working on community-based health improvement issues. The illustrations are offered in the context of higher education, and the many barriers to making change that must be overcome. The work of the Collaborative provides valuable illustrations of successful activities to promote and create change, and ultimately to achieve improvement and interprofessional learning, better preparing new health professionals for the health systems in which they will work.

Attitudes about End-of-Life Care: A National Cross-sectional Study

Major concerns have been expressed about the preparation of physicians to provide end-of-life care. Little is known about how well academic health centers prepare students and residents to care for patients at the end-of-life and about the values about end-of-life care transmitted by faculty. In 1997, we conducted a telephone survey of a nationally representative sample of first-year medical students (n = 287), fourth-year medical students (n = 173), residents (n = 473), clinical faculty (n = 728), internal medicine residency training directors (n = 143), department chairs (n = 186), and medical school deans (n = 101) within U.S. academic health centers (response rate = 80.2%). U.S. medical students, residents and faculty evaluate themselves as inadequately prepared to provide end-of-life care. Academic health center constituents perceive that providing care at the end of life requires medium to high levels of expertise. Academic health center constituents are divided about whether responsibility for providing care at the end of life rests with generalists or with specialists and view managed care as nearly equivalent to the fee-for-service sector in its capacity to provide excellent end-of-life care. Academic leaders and faculty, as well as their students, lack confidence in their own skills in providing end-of-life care. They also question the ability of the current and evolving health care delivery system to provide excellent end-of-life care.

CRITICAL CARE IN THE UNITED STATES: Who Are We and How Did We Get Here?

Critical care medicine has progressed significantly over the past two to three decades. We will review the history and evolution of critical care medicine and ICUs in the United States. The evolving health care delivery system and the changing and important role of the intensivist will be addressed. Finally, a discussion about what critical care physicians must do to prepare for the future is presented.

Training Psychologists for a Future in Evolving Health Care Delivery Systems: Building a Better Boulder Model

Recent and dramatic changes in the demand for and reimbursement of psychological services and expertise in health care delivery systems have radical implications for the preparation of psychologists at the predoctoral, internship, and postdoctoral levels. In order to respond to these changes effectively and advance the profession, training programs must realize the expanded and potential role of psychological expertise in evolving health care delivery systems. In this paper, we review several limitations and unfortunate consequences of traditional training programs that have confined the scope of research and practice to the realm of “mental health.” We propose that future psychologists be recognized and trained from a broader perspective as “behavioral scientists,” prepared to operate at the highest levels of health care delivery systems. Specific recommendations for training and education are discussed.

Changing associate degree nursing curricula to meet evolving healthcare delivery system needs.

Curricular change for evolving healthcare delivery: everyone says to do it, but how, and what do you do? The authors explore the need for curricular change, a process to use in making the changes, essential elements to explore, and what changes one community college made. Included in the curricular revision is the hardest part-what was deleted-as well as what was added, and how nurse educators can continue to evolve.

The application of antitrust laws to the healthcare industry

The move toward managed care initiatives and multiprovider networks has intensified in recent years in response to escalating healthcare costs and increasing market dominance by the insurance industry. As a consequence, the antitrust laws have played a significant role in defining the limits of physician cooperation. An understanding of the application of antitrust laws to evolving healthcare delivery systems and a knowledge of the specific areas where providers must exercise caution are essential to physicians' strategic planning. This article looks at the major areas of innovation emerging in the healthcare delivery market and details some of the most important guidelines for safeguarding physician collaborations. The authors compare the ability of physicians and insurers to organize integrated care systems and question the continued protection of the insurance industry under the McCarran-Ferguson Act.

Health care in the 21st century: marketing's role in vertically integrated delivery systems.

Health care delivery has become one of the most significant economic and political issues of the 1990s. Historical efforts to reform the system to reduce costs while providing quality care to an ever-expanding population have not proven to be satisfactory. With attempts to restructure the industry for the 21st century come important implications for the marketing of health services. This article reviews the economics of the issues, historical efforts to control costs, and activities in the 1990s to restructure the industry. From this, implications for marketing's role in an evolving health care delivery system are described.

Assuring Quality Cancer Care In an Evolving Health Care Delivery System

Assuring Quality Cancer Care In an Evolving Health Care Delivery System