This is the Healthcare Delivery Providers part of the Healthcare Marketplace Specialization. This is Module 1.2.1, Overview of the Lenses. So the learning outcomes for this lecture are that we will look at the various lenses that we will use to dissect the delivery system. Sites of delivery, the people, the money that flows either as a way of the payment or the payers and obviously the customer, or the patient. One of the concepts that we will talk about in this lecture is the concept of social determinants of health or the factors that control or contribute to health for patients. So in this lecture I will try to portray for you how we need to look at the healthcare delivery system and the providers within it. So I want you to imagine a box that we will be unpacking. And so, this is a three dimensional or four dimensional complicated a scenario of moving parts. And the healthcare deliver providers and the patients are but one thing or one stakeholder that moves through the delivery system. So imagine a box with the patient at the center and it's a three, four dimensional issue, so maybe one dimension might be the healthcare delivery system, the hospital, the clinic. Another dimension might be the payer. So the insurance company or the customer patient that is paying herself. Another dimension might be the healthcare worker. So the physicians, the nurse, the social worker. Another dimension might be the need of the patient herself. So how sick is she? Does she have a home to live in? What's her socioeconomic status? So again, that's the point of this particular brief lecture, is to make sure you understand that the healthcare delivery system is not a one dimensional way of looking at things, but rather a complicated environment of many different moving stakeholders and parts that come together. To make up this very dynamic environment that we will slowly unpacking, unpeeling, as a way to understand the various healthcare delivery providers. So let me talk a little bit more about it, and then we will get started looking at each of the lenses individually. So as I said, let's imagine in our mind a box with multiple different sides to it. So obviously the main thrust of this particular course is the gear delivery site where the care is provided the clinic or the hospital but there are many other sites to this box that you need to think about. So the primary one obviously is the customer need so this is where Harlan Reeves and his family comes in, so what does the customer want and need? What type of living situation, family history, medical history does the customer have, and what actually are the medical needs of the customer? Another very important axis that we will look at is on the stream of money. So who pays, so who are the payers for healthcare delivery and how exactly is the payment calculated. And then, another very important dimension is the healthcare workers. Sometimes we forget about the human resources and the human dimension in the healthcare delivery, and we will focus a little bit on that. And then, all of these factors together really try to create value and so we will think about value as a three or four legged stool. And I will talk in more detail about that in an upcoming module. But this is the emerging concept of the triple or the quadruple aim. And then, finally, in this particular lecture I want to draw your attention to this very important distinction between healthcare. So it seems we sometimes just talk about healthcare as the medical care or sick care that we are providing. And we forget about the much more important concept of health. So what is health for an individual? What is health for Harlan? Is it the medications that he is taking? Is it the congestive heart failure diagnosis that he had? Or it held for him something different. For example, living peacefully with his wife in his own home and away from the hospital and away from a nursing home. So again, this is very important concept of healthcare versus health is something we will explore in this particular lecture. At this time, let's take a short quiz. So as we discussed before the quiz, I want to start with this very important concept that is emerging and becoming much more important and talked about in the US and across the world. There's a whole section in the World Health Organization, WHO, devoted to Social Determinants of Health and I encourage you to Google that and find that, it's a great resource, so again Social Determinants of Health are determinants of population health. And this study really tells us that healthcare, which is the medical care, the access to care, or the quality of care, only contributes and is directly related to about 10 to 20% of population health or health outcomes. There are much more other weighted factors that have everything to do with the individual health or population health. And some of these factors are, about 40% of the time it's the socioeconomic factors of education, employment, income, family and social support, and community safety that has everything to do with individual and population health. 30% of the time it's the individual's health behaviors. And sometimes the population's health behaviors. So how many patients or community dwellers in a zip code smoke? Do they have a good diet? Do they have what are called food deserts? So there's no place to get good healthy food like fresh vegetables. So folks are really forced to look at high carbohydrate, high fat foods and junk food. So are they dieting? Are they exercising? Are there even trails to be able to exercise? What is the usage of alcohol? What's the prevalence and incidence of unsafe sex in this population? So again, for these 30% of the times and these 40% of the time impact that these factors have on population health, it's a very different than to 10 to 20% healthcare providers. So I want us to be very, very clear that when we are talking about the healthcare providers we are only looking at this 10%. There's a whole other world that we need to keep in mind of health behaviors, socioeconomic factors, physical environment. So does the person in question have a house? What is the built environment? Are there roads, are there bike trails? So again, that's a very important concept as well, so I want you to remember the social determinants of health, I also want you to remember that we will be focusing heavily on the healthcare, the medical aspect of healthcare. But there's this other world which really controls about 70 to 75% of healthcare that is outside of the typical healthcare delivery that we think about. So I'll give you a couple of examples of how these potential lenses could be used, or how these various dimensions interact. So here is Harlan Reeves and his context, his wife, his socioeconomic status has everything to do with how he accesses the healthcare delivery system of either the hospital or the primary care provider, the clinic. And so, if he has transportation, if he has a car, if he has a wife who has the time to take him into the primary care provider, he's going to be able to make it there. If he does not have transportation, his wife does not have time to drive him, maybe he's not going to be able to make it to the primary care provider. So again, that simple context of the built environment socioeconomic factor, has everything to do with if he's even going to get to the primary care provider. Which will then help him to reduce his incidence of heart attacks and congestive heart failure, and reduce him from going in to further decline. So again, here, transportation as one example. The support structure he has of his wife and his family is much more important than the primary care provider and what the primary care provider can do for it. Let's take another example. Again, we will use Harlan in the case study. So let's say Harlan wants to go to the gym. And he would like to start working out on the treadmill and start running on the treadmill as a way to lose weight. He's very motivated, he has the way to get to the gym, and wants to get his weight and his blood pressure under control. But then something gets in the way. And that something might be a payer source. So let's say the insurance company that he has will not pay for him to go to the gym. And if he does not have his own money to pay for the gym, and if the insurance company or the payer source that he has, does not view going to the gym as a covered benefit, then he's not going to be able to go to the gym,. And as a result all of his hopes of trying to get to the gym and prevent further heart attacks are really dashed. Because of yet another stakeholder or dimension of the payer. So this is another example of how we need to take the delivery system in context with all of these other forces that are at play. So in summary, we have seen that providers of healthcare delivery what we are going to be mostly focusing on, they have to be taken in the context of many other stakeholders, and thus the concept of the box with the multiple lenses is very important for you to remember and understand. And the other point is that the providers, the health care workers like physicians and nurses, and the payers interact in very complex ways with the patient and his or her living situation. So it's a very dynamic, very living environment where all of these factors come into play and help mold and shape each other.
