Toolkit for thinking

The diagram illustrates how to connect your priorities to some methods that develop insights and action plans.

Tool Kit
Tool Kit

… a bit more …

  • Payer Logic, Evidence Generation, Health Technology Assessment. Payer logic is analysed to identify the structure of their decision-making that involves adoption of new products, such as medicines. These are called gated processes. They will help pharmaceutical clients, for instance, determine what evidence generation or health technology assessment priorities they must respond to.. Knowing what these gates are and the success criteria for passing through the gate has considerable commercial significance to industry.
  • Performance, Pricing, Quality.  The Triple Aim approach helps pinpoint priorities in hospital or provider costs and quality, determine value for money, match organisational performance to patient satisfaction, and establish performance evidence of a healthcare provider’s fitness for service delivery. It is used to calculate the actual value of a new product to inform pricing negotiations as part of value-based pricing. The Triple Aim uses three criteria; quality of care, patient satisfaction and cost. See Don Berwick, and colleagues for the original paper, The Triple Aim: care, health and cost (Health Affairs, 2008, 27(3):759-69) .
  • Thinking like the customer and going “beyond the pill”. The shift in power, toward payers, has increased the need for various healthcare groups to rethink their practices. For example, for the pharmaceutical industry this has meant shifting from product features to patient adoption (adherence) which drives the value-for-money equations payers use. For providers, such as hospitals, total quality and whole systems now need to focus on patient engagement and results.
  • Decision Making, Priorities.  Decision architectures, strategy maps and logic models are used to identify critical aspects of whole care systems, deal with challenges that involve multiple providers, or involve understanding  the movement of patients or flow of funding. These produce important insights for identifying problems, and developing solutions.
  • Interest Groups and Trade-offs. All healthcare decision-making (by payers, providers or policy makers) involves, in one way or another, a complex of trade-offs amongst competing interests. It is important to identify and assess the implications of business strategy or public policy involving how costs and benefits are distributed. It is also important to assess policy options (for those preparing formal responses to government consultations), or those wishing to establish a powerful position on some issue of political importance. As a methodology, it is also used  to game a  regulatory regime to identify weaknesses. It is built on work by James Q Wilson, The Politics of Regulation (1980).