The 1st Dimension of patient centered care has the most variables of a counterfactual nature. Counterfactual properties of interoperability and possibilities that define the pathways that exist within the ecosystem make the moment of the care event organic.
The moment of the 1st Dimension of the ecosystem including clinical care, receives input from value-based purchasing, control of provider networks, and policies of insurance plans which pose a burden on providers. They contend with care plans, complex clinical events, multiple requirements of quality compliance, documentation, utilization review, and when assembling these into a single moment of a care it is no wonder providers feel overwhelmed by this Maze. When the moment is organic, the burden evaporates. It is counterintuitive to realize the health care ecosystem offers a way out of this Maze. Reimagining the clinical event as an organic event, these moments only need a few inputs. Organic events exist uniquely as patient centered moments. Any input to the microscale of the 1st Dimension (Patient), from the mesoscale of the 2nd Dimension (Network) and the macroscale of the 3rd Dimension (Value) is also uniquely organic.
When matched to patient centered health and disease variables, the burden of the maze reduces with counterfactual analysis. This reduction step has several features, starting with the full scope of the information of the ecosystem. HCn3D frames the ecosystem as a group of pathways touching moments that are patient centered. Framing care with attendant inputs as pathways is the first reduction step by leaving out many ecosystem variables that do not contribute to the course of the pathway. The next step is to link the objective of a pathway, which is an outcome, to the process that resulted in an outcome. The many steps constituting moments have compliance inputs that do not contribute to the outcome. An example is preauthorization and the burden it imposes in the moment and to the insurance plan. When the pathway’s outcome defines the utility of the service subject to preauthorization, the cost control purpose of preauthorization becomes irrelevant. Counterfactual analysis with interoperability and possibilities trumps the need for preauthorization and is therefore a reduction step. Further reduction steps are described in the Network Dimension 2.
More than managing the burden imposed on the Moment, patient centered organic Moments signify many levels of facts and counterfactual possibilities. Clinical care has more features than simply medical decisions. These include effects on health from social determinants, psychosocial burdens, care access and more personal and social aspects. Organic care, guided by wise clinicians, has features not captured as data in structured organizational systems. These features however readily inform the quality and completeness of decisions deemed medical. The details of the moment when factored into clinical decisions reflect these unmeasured variables, which are therefore counterfactuals. These pathways, effected by unmeasured variables, can have a profound effect on costs, for example, ER visits.