Correlating cost and outcomes is the objective of Health Care in 3 Dimensions. More than a focus on specific services and their costs, the HCn3D tool expands the journey into cost saving with a broad based view of all factors that may and usually do impact cost. The movement into value based purchasing is just beginning and drivers are population based through the vehicle of comparison of provider performance for common patient centered treatment events summed as benchmarks. It is clear that costs emanating from populations, small and large, must be linked to costs at the patient level. Providers must have a tool to gain insight into patient and provider network particularities to know how to adjust their decisions and have this reflected as a change in value. Generally value is a challenging metric by forcing the perception of the need for behavior change, yet not specifying exactly what providers need to do to cause this modification of care processes.
Because HCn3D, as a model building tool, structures data from the complete world of the health care Network, even when data is not available , all factors that impact care processes can be modelled. By doing this model building step, network entities as business organizations from the patient level to the largest plan, can be seen as the purveyors of information which can be more useful when channeled through the network links. When value is thought of as a financial reflection of care processes, linkage can include all network entities; more specifically when care processes are modelled as granular events in a patient’s journey , linkages need only include those provider entities directly involved in patient care. Thinking of business organizations as network entities allows a variety of links to operate to bring together measures appropriate for the tasks at hand for each entity.
Classification of information is needed to understand the role of each network entity in their capacity of linking to each other, usually in multiple ways. In the schema of HCn3D this classification is broadly called executive functions, and when applied individually to network entities, the basis for defining links is created. Starting with the transactional nature of the fundamental processes of all network entities, information mapping steps are needed to define and classify the links among the network entities. These classifying steps are called in the terminology of HCn3D executive functions, of which there are 4. The first is Transactions [T], next is Translations [R], then Transitions [A], lastly Transparency [S]
- Granular events that generate codes and billable services trigger mapping to evidence based metrics, used to document complications.
- Granular events when communicated between network entities, such as billing codes from providers to insurance companies. These events can be summed, aggregated, attributed among entities; comparison among entities such as provider performance based on benchmarks; semantics apply when transactions are communicated among network entities to reflect varying understanding of terms. Priorities can be attributed, such as highly granular care processes for providers at smaller scales in the network; and summed transactions for higher scales in the network where financial aggregates are important.
- Originating with any network entity, units of measurement specific for an entity can be trended and the integrity of the data tracked over time known; this includes the order of services or disease behavior, inclusion of multiple providers in network neighborhoods, inclusion of network entity links as trackable data points themselves; broadly this is the patient journey and how episodes of care and instance of care sum over time. This is the basis for comparison of performance of provider networks in value, and is a higher and more complex way to look at value.
- Information communicated among network entities require the mapping semantically to reflect Logic, outcomes and financial measures; also technical manipulations of the information for aggregation by statistics, probabilities and by counterfactual calculus is needed to communicate quantitatively among the network entities.
These functions operate within the Network as a whole, and serve to link semantically and quantitatively the operational business entities of the Network.