Coordinating healthcare networks
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Current healthcare reforms advocate significantly to improve the coordination of services around a patient-centric model, with an overarching goal to maximize patient outcomes with lower cost, i.e. a value-based care. With most patient care delivered through outpatient services, the need to coordinate different services and their patient appointment scheduling decisions becomes central to successful reform. Currently, outpatient services are particularly fragmented with minimal coordination among different providers, and the coordination is left to the patient. This approach causes compromised patient health outcomes, an increase in missed appointments and unacceptable access delays. Therefore, the potential impact of coordinating outpatient services is great, in terms of improving patient outcomes and satisfaction, optimizing providers’ utilization and reducing operational costs. In the first study, we investigate how to coordinate the delivery of care in the preoperative process for surgical outpatient. Based on the concept of the Perioperative Surgical Home proposed by the American Society of Anesthesiologists, we develop a Patient-Centered Surgical Home (PCSH) model. Using statistical analysis and simulation, we demonstrate how this can be implemented and reveal the potential benefits on cooperation of the referring clinics and integrating patient in- formation early in the preoperative process. The second study proposes a multi-station network model that sequentially schedules patient appointments in a network of stations with stochastic service times, no-show possibilities, and overbooking. We propose a myopic coordinated policy and present evidence that the policy yields a solution that is close to optimal and is computationally feasible. However, the solution is not simple enough for practical implementation. Hence, we explore a sequence of approximations and find one that offers a tremendous computational advantage. We also provide several managerial insights and discuss how network structures affect complexity. In the third study, we focuses on the cost perspective of coordination. We formulate a multi-server, multi-clinic model that represents the current practice at the PCSH and develop a coordinated scheduling method that dynamically balances the utilizations of all services as patients are sequentially scheduled in the PCSH. We compare our proposed policy against other policies found in the practice and the results shed light on the risk of improper coordination in our increasingly interdependent healthcare system.