Health Care Value Chain
Professor William Wan
‘Value’ in Health Care
Value = Health outcomes/Costs
of delivering the outcomes
Firm Value Chain
(Swayne et al)
Primary
Activities
Pre-Service
Point-of-Service
*marketing/marketing *clinical operations
research
- quality
*services
- process
offered/branding
innovation
*pricing
*marketing
*distribution/logistics
- patient
*promotion
satisfaction
After-Service
*follow-up
- clinical
- marketing
*billing
*follow-on
-clinical
-marketing
Organization Culture
*shared assumptions *shared values * behavioral norms
Support
Activities
Organizational Structure
*function * division * matrix
Strategic Resources
* Financial * human *information * technology
Add
Value
Firm Value Chain
Pre-Service
Point-of-Service
*clinical operations
Primary
Activities
After-Service

- high efficiency (20
minutes turnaround time)
- no meal (gives
beverage/snack )
- no seating assignment
(pick your spot)
Organization Culture
Support
Activities
Organizational Structure
Strategic Resources
Add
Value
Firm Value Chain
1. What are the resources/capabilities
for the activities?
Pre-Service
Primary
Activities
2. To what extent are they valuable, rare,
inimitable, and nonsubstitutable?
Point-of-Service
*clinical operations
After-Service

- high efficiency (20
minutes turnaround time)
- no meal (gives
beverage/snack )
- no seating assignment
(pick your spot)
Organization Culture
Support
Activities
Organizational Structure
Strategic Resources
Add
Value
Care Delivery Value Chain
Support
Activities
(Porter)
Knowledge
Management
Informing
Measuring
Accessing
Monitoring/
Preventing
Diagnosing
Primary
Activities
Preparing
Intervening
Recovering/
Rehabilitating
Monitoring/
Managing
Patient
Value
Care Delivery Value Chain for Glaucoma
(Buhlmann, 2009)
Knowledge
Management
Informing
*life style
counseling
*diet counseling
*explanation of
the diagnosis &
implications
*education on
procedures
*life counseling
*medication
counseling
*medication
counseling
*lifestyle
counseling
*medication
compliance
follow-up
*lifestyle
counseling
*IOP, tonometry
*IOP, tonometry
*visual field test
*Ocular fundus
*Nerve fiber scan
*procedurespecific pretesting
*Procedurespecific
measurements
*IOP, tonometry
*IOP, tonometry
Retinal nerve
fiber layer
thickness
*office visits
*lab visits
*office visits
*lab visits
*various
*office visits
*hospital visits
*office/lab visits
*Telephone/
internet
interaction
*office visits
*Lab visits
Telephone/
internet
interaction
Measuring
Accessing
Monitoring/
Preventing
Diagnosing
Preparing
Intervening
Recovering/
Rehabilitating
Monitoring/
Managing
*monitoring IOP
*monitoring &
addressing risk
factors
*early specialist
referral for
abnormal IOP or
ocular fundus
*medical & family
history
*Dedicated
advanced testing
*consultation
with other
specialists
*formal diagnosis
*formulate a
treatment plan
*procedurespecific
preparation
*tight IOP control
*pharmaceutical:
IOP lowering
drugs/eye drops
*fine-tuning of
the drug regimen
*determining
supporting
nutritional
modifications
*managing IOP
*monitoring
visual field
*managing
aqueous fluid
production
*procedures:
trabeculectomy/
micro plugs
Patient
Value