This article is the second in a series on the components that influence the value of novel healthcare solutions and how to address them.
In the first article of this series (link), I laid out the components I believe influence the value of novel healthcare solutions. Here they are along with the activities that are necessary to address them:
In this article, we will discuss the first activity: mapping the care pathway.
Mapping the Care Pathway
Regardless of where and when in the patient’s journey your innovation impacts care delivery, it is helpful to understand the full pathway patients take from start to finish. This helps to identify relevant care settings, materials, procedures, and clinical staff who may be involved, as well as whether those staff are directly involved (e.g., a nurse) or indirectly involved (e.g., a lab tech who processes a blood sample). It also allows one to identify antecedents that may influence the value your solution and down-stream outcomes or events that your solution affects.
For example, say that you have a solution that reduces the likelihood of adverse events during surgery. Instead of just thinking about what happens in the operating room, consider the full journey that a patient takes from hospital admission to discharge and even follow-up care. Maybe there are patient characteristics (e.g., their comorbidity burden) or previous experiences (e.g., a certain medication prescription; a previous procedure) that change their risk of a surgical adverse event. If these characteristics or previous experiences increase the risk of an adverse event, they may make your solution even more valuable, because at volume your solution will avoid more of the associated adverse events. Post-operatively and post-discharge, perhaps your solution reduces length-of-stay or the rate of readmission; for the patient, maybe it lowers the likelihood of functional decline or makes it more likely they will return to work sooner, etc. Understanding the relationship between events and actions across the care pathway ensures that you can identify all the value your solution may confer. Mapping the pathway can allow you to see how your solution may influence care and outcomes at other points in the pathway, thereby revealing additional benefits to alternative stakeholders that you may not have otherwise considered.
Different locations in the care pathway may also affect the potential value to different stakeholders. Solutions involved in the “prevention” and/or “early diagnosis” stages (see figure below) may represent an immediate and large reduction in costs to payers by avoiding future care utilization, while a solution that reduces the cost or time to deliver care during the “treatment” phase may be of significant value to hospitals and health systems looking to make care delivery more efficient (especially if they are receiving a capitated payment). Some pathways cross multiple settings and involve multiple care providers; a full picture of these interactions is necessary to truly describe how your solution will capture value.
If your solution results in a change in the care pathway from its traditional course, it is critical to identify where in that journey it will occur and who is affected. This allows you to determine how disruptive the solution might be and who will bear the cost of that disruption, even if that cost is measured in time or effort instead of in dollars. Mapping the care pathway will also be useful in identifying potential barriers and sources of uncertainty (e.g., Will front-line nurses really have the time to incorporate this new device? How and when would clinicians determine which patients are good candidates for this new solution? What additional technology may be needed?). It can also help you determine what data or evidence you need in order to demonstrate value to particular stakeholders. Often, data related to efficiency (time savings), waste reduction, and resource allocation is hard to find in existing studies. If you understand the care pathway, then you will know what type of data to collect, how to measure it, and how to convert it to value that is relevant for specific stakeholders.
The audience(s) you ultimately select for your value messages will want to understand how the costs and benefits (monetary and otherwise) flow, both currently and under your proposed change. Having a clear picture of the pathway allows you to illustrate that flow, how it happens, and when. It also makes it easy to demonstrate the gap in care you are attempting to address, and how your solution will address that gap (and what it will change and for whom).
The form the mapping takes may depend on several factors, but at a minimum, you should be able to describe the individual steps and understand relevant components, which may include:
- Timing (real time and relative to other steps)
- Settings of care
- Clinical staff
- Diagnoses and procedures
- Events and outcomes
- Costs, payments, and reimbursements
- Gap(s) in care delivery, efficiency, patient outcomes, and experience
The information gathered during the mapping process will inform subsequent activities, including the next one we will discuss: exploring relevant perspectives. Understanding the care pathway will allow you to identify who is involved, when, and how value flows to and from those individuals throughout the process. This is critical to identify the appropriate perspectives from which to assess the change in value of your innovation, and helps to confirm where there is existing demand for improvement, and from whom.