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Is there a business case for quality in health care?                                            Eliel Arrey, M.D., Tracy Kenney, BA., Cameron Knox, BS., Diane Pham, BS., and Aurelio Vargas, BS.   Texas A&M Corpus Christ - College

10/24/2017

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The answer to there being a business case for quality in healthcare is a long, complex, and somewhat controversial one. Quality in health care as it pertains to optimal patient outcomes, safety, and efficient service are pivotal to patient centered care and one any human will agree to its improvement. On the same token, improving quality in health care is the fiduciary responsibility of all medical providers. So yes, we contend that there is a business case for quality in health care. The inability to truly quantify a positive financial return for quality improvement (QI) initiatives and the variety of reimbursement systems in healthcare are a couple of strong reasons why the business case for quality in healthcare is not as widespread as one would expect.1, 2  This short narrative will discuss how several issues in the healthcare business sector affect the business case for quality, and review a few suggestions of our own on why quality improvement programs in healthcare are more than just another expense but are programs that have a good return on investment that benefit all interested parties, with patients being at the forefront.  

Quality seen as an expense:
The current situation in the healthcare business sector is that QI projects are hard to quantify and define. In a 2007 survey administered to chief medical officers (CMO) at four urban nonprofit, acute care teaching hospitals, there was great variability in how each of these hospitals allocated their funds for QI projects.  Inpatient QI projects ranged from $2 million to as high as $21 million.3 Thus, QI projects are widely seen as an expense or in some cases, a necessary cost to maintain accreditation or respond to regulations.3, 4  With an increasing number of quality metrics, and regulatory and accreditation agencies, there is growing support for the business case of quality in healthcare.

The return on investment (ROI):
No matter how well-intended QI projects may be, the difficulty in sustaining many of these projects as mentioned above lies in the time for the QI to result in an economic benefit to the investor and the beneficiary.9  Naturally, the earlier the ROI occurs, the greater the value of the QI and the stronger the business case for said QI program.10  In regards to the relationship between investor and beneficiary, Dr. Gross elaborates in his article, “when the ROI goes to the same party, the business case is self-evident.”9 The dilemma in the past was that hospital institutions spending money on new QI projects in order to be in accordance with departments such as Joint Commission (JCO) never were able to quantify any economic return. The beneficiary, according to some, was “the patient and society.”9  Nevertheless, in 2013, Swensen et al. made the case that beneficiaries to QI programs were the patients, insurers, employees, and providers.4  The institution of payment services like pay-for-performance helps reward hospital institutions that invest in QI programs that lead to better safety outcomes. We will discuss this in more detail under reimbursements.

Measuring Quality in healthcare:
Quality in healthcare is generally patient focused. It's a never ending process where quality criteria is set, data is gathered, data is reviewed using statistical tools, and then used to develop quality improvement efforts or identify issues. New criteria may evolve and the process starts over again. While quality concerns does not prevent all poor outcomes, it does increase more positive outcomes on desired care.12

Avedis Donabedian,5 the “father of quality assurance”, described the aspects of quality as: 

1. Resources used in care
2. Activities involved in providing care
3. Outcomes as consequences of care
He further identified attributes of quality which are efficacy, effectiveness, efficiency, optimality, acceptability, legitimacy, and equity.5 Many models have been developed to measure quality based on Donabedian’s work;6, 7 however, it's also important to consider case variety, patient illness, and conditions when evaluating quality measures.

Quality and its potential effects on provider liability:
We agree with Swensen et al. that clinical QI can deliver “net operating income if managed appropriately.”4  In their four year administrative date examination of the relationship between safety outcomes in hospitals and malpractice claims against providers in California, Greenberg et al. were able to demonstrate that a decrease in adverse safety outcomes from QI programs was associated with a decrease in the volume of malpractice claims.8 Their report supports the business case for quality in health care to not just improve patient safety outcomes, but to lower liability costs to providers.

What role do reimbursements play in the business case for quality?
​Reimbursements affecting the business case for quality: Fee-for-service reimbursement encourages overuse waste (provider related).  Reimbursements received from length hospital stays due to preventable complications have been captured in fee-for-service payment systems.  Value-based purchasing and pay-for-performance reimbursement models have become significant in supporting the business case for healthcare.  Providers need to be concerned with quality as it is directly related to receiving payments. The government implemented a Pay-for-Performance program and Hospital Value-Based Purchasing Program.12  Pay-for-performance (P4P) requires providers to submit data on an initial set of 10 quality indicators. If hospitals fail to submit, they will receive reduced payment. In return, the Hospital Value-Based Purchasing Program offers incentives with higher payments to providers for higher performance and/or improvements. While research to date does not suggest the effects of P4P, it obviously affects the bottom line of most organizations.12

What makes a strong business case for quality in healthcare?
In 2002, Michael D. Pugh stated that the business case for quality “varies by the type of improvement.”  He went on to describe a very strong case for QI: projects that readily decrease unit cost or projects that lead to higher productivity.  He described moderate cases for quality as those that only add value to products or services (an example will be employee bonuses for improved quality) or increased customer and patient satisfaction.9    

Reducing Waste:
​
In their very elaborative review of “The Revolution in Health Care Delivery,” Swensen et al. declared emphatically that as much as “40% of healthcare dollars” spent is waste, specifically provider-related.11   We have previously mentioned one form of this waste, which is overuse. Other forms of provider-related waste include inefficiency and preventable harm.4  Swensen et al. do caution on the difference between waste and cost, and make the point that simply removing workers in an area to reduce cost will always erode quality.4  Reducing waste through effective QI programs results in direct benefit to patients, insurers, providers, and hospitals.

In conclusion, the business case for quality is a very broad and complex topic. Mainly because quality is complex and in some cases, depends on perspective. From a business perspective, resources are limited and the difficulty to quantify quality in healthcare or define how much of an institution’s revenue should be allocated to QI programs hurt the business case for quality.  Nevertheless, the business case for quality has more pros than cons as we have elaborated on, from patient safety, decrease in provider liability, ROI, pay-for-performance systems, and maintenance of accreditation.  Continual improvement of quality in healthcare will benefit all parties, the hospital institution, healthcare providers, employees, and above all, the patients, to whom we owe a fiduciary responsibility.




References:
1)Brown SES, Chin MH, Huang ES. Estimating costs of quality improvement for outpatient healthcare organizations: a practical methodology. Qual Saf Health Care. 2007;16:248Y251.

2)Leatherman S, Berwick DM, Iles D, et al. The business case for quality: case studies and an analysis. Health Affairs (Millwood). 2003;22:17Y30.

3)Chen LM, Rein MS, Bates DW. Title costs of quality improvement: a survey of four acute care hospitals. Jt Comm J Qual Patient Saf. 2009;35:544Y550

4)Swensen SJ, Dilling JA, McCarty PM, et al. The Business Case for Health-Care Quality Improvement. J Patient Saf 2013;9: 44Y52

5)Donabedian A. Evaluating the quality of medical care. Milbank Memorial Fund Q. 1966;44(3)(suppl):166‐206. Reprinted in Milbank Q. 2005;83(4):691‐729

6)Berwick D, Fox DM. “Evaluating the Quality of Medical Care”: Donabedian’s Classic Article 50 Years Later. The Milbank Quarterly. 2016;94(2):237-241. doi:10.1111/1468-0009.12189

7)Ayanian JZ, Markel H. Donabedian's Lasting Framework for Health Care Quality. N Engl J Med. 2016 Jul 21;375(3):205-7. doi: 10.1056/NEJMp1605101.

​8)Greenberg MD, Haviland AM, Ashwood JS, Main R. Is better patient safety associated with less malpractice activity? Evidence from California. Santa Monica, CA; Rand Corp, TR-824-ICJ. As of January
16, 2011: http://www.rand.org/pubs/technical_reports/TR824 2010.


9)Gross PA, Ferguson JP, DeMauro P, et al. The business case for quality at a university teaching hospital. Jt Comm J Qual Patient Saf.2007;33:163Y170.

10)Weeks, W.B., Bajian, J.P. Making the business case for patient safety. Jt Comm J Qual Patient Saf. Jan. 2003;29:51–54.

11)Swensen SJ, Meyer GS, Clancy CM, et al. Cottage industry to postindustrial care - the revolution in health care delivery. N Engl J Med. 2010;362:e12, February 4, 2010.

​12)Finkler, Steven A., Jones, Cheryl B. & Kovner Christine T. (2013). Financial management for nurse managers and executives FOURTH edition. St. Louis, MO: Saunders Elsevier.





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Singer Yolanda Arrey drops an Epic Anthem on 'The Essentials' from EA Music - Press Release

4/21/2016

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The Cameroonian-born singer known as Yolanda Arrey is a prominently featured artist on the new LP record from EA Music Group and mastermind musician Eliel Arrey.  Yolanda Arrey happens to be the second Cameroonian-born talent holding nothing back as she steps unto the world stage on the track 'Your Highness.'  The new long-playing album featuring Yolanda and other artists such as Nasomi, Steve Owner, and Melissa Otero, “The Essentials,” is available for download online [link provided below].

Early rumors of Yolanda's involvement in this full length album initially broke out in the February 2016 press release for Eliel Arrey's "End of Days" which listed her as a vocalist in EA Music Group.  Eliel Arrey never responded to any comments in regards to the extend of Yolanda's collaboration and that was kept a mystery until now.    

Something that certainly was not a mystery then or now, is Yolanda Arrey, the singer. Described in an article as "Salt Lake City's finest," Yolanda is no novice to the music scene. She has been singing and writing her own songs since she was seven years old and is well known by many  Cameroonians around the world. She cites Whitney Houston as one of her main artistic influences, a singer well known for her strong vocal presence, an attribute that marks Yolanda's own style.

 Another well known fact is her love for old school Jazz and Soul music.  Her songs bring a soothing memory of what some would say 'real music used to be.'  When asked about Yolanda, Eliel Arrey said "She is just too good. She gives her all into every song and her type of music definitely fits into what any would call the trademark 'Motown sound.'' 

Yolanda has been known to step out of the Jazz scene from time to time, making the idea of a collaboration with a near genre-free music composer such as Eliel Arrey not so far fetched.  In December 2013, she collaborated with the acclaim rapper Prince of Cats on a Hip-Hop/Rap song titled "When You Loved Me."  That magnificent piece was a success and  garnered numerous audiences worldwide.

'Your Highness' is a track that demonstrates the evolution of both Eliel Arrey and Yolanda over the short courses of their musical careers:
- On the one hand, we see that Eliel Arrey is not shy to step away from his traditional EDM zone that has celebrated him for so long.  Nor is he shy to step away from the new symphonic scene that seems to be his new identity.  He demonstrates, with emphasis, that he can walk into a brand new universe and still keep us dancing.  Time after time, Eliel Arrey has shown us he is "...broadly varied [and] emotionally evocative."  McCauley 2016.
-On the other hand is the Diva in the room,  Yolanda Arrey.  Her works just never cease to amaze.  Although she launches into the song with a soft and warm vocal, it does not take long for her to leap into her full range of strong natural tones and pitch perfect precision. The sweet, short, and catchy melodies of 'Your Highness' will keep many listeners hitting 'repeat' all year long. This song arguably might be this summer's most played anthem. 

Like everything else we are presented with on 'The Essentials,' it is world-class writer McCauley who describes it best: "With nearly every emotional hue coloring this striking example of unbridled innovation and musical alchemy, it's improbable that the music fan won't hear himself in it somewhere." 
McCauley 2016.

“The Essentials” by Eliel Arrey from EA Music Group is now available online worldwide featuring Salt Lake City's finest, Yolanda Arrey on 'Your Highness.'
 

https://itunes.apple.com/us/album/the-essentials/id1097226089

Website –

www.elielarrey.com

Download album today
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Singer Nasomi featured on 'The Essentials' from EA Music - Press Release

4/15/2016

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SUMMARY:

The Cameroonian-born singer known as Nasomi is a prominently featured artist on the new LP record from EA Music Group and mastermind musician Eliel Arrey.

PRESS RELEASE:

The Cameroonian-born singer known as Nasomi is a prominently featured artist on the new LP record from EA Music Group and mastermind musician Eliel Arrey. The new long-playing album featuring Nasomi, “The Essentials,” is already available for pre-order online [link provided below].

While Eliel Arrey's “The Essentials” has been garnering no end of attention from music lovers and game aficionados alike, Arrey himself stresses that Nasomi's performances are among the album's best qualities.

“Nasomi is definitely an artist I'd like to emphasize on my album,” writes Arrey, who is renowned for writing evocative, highly narrative compositions. “She is the lead singer on 'Rise,' 'Brand New Day/Dance with Me,' and 'Sunset Love 2.0.' Nasomi has one of the most powerful voices of any artist I know. She has the ability to listen to any melody I write and complement it with the perfect vocals. She is masterful at conveying emotions through music. Her lyrics have touched many souls and have inspired many people, including me.”

The Holland-based Nasomi cites as main artistic influences Toni Braxton and Aaliyah, two singers well loved for strong natural tones and a surgically precise pitch, both of which are marks of Nasomi's own style.  

“Nasomi is an artist who takes her music very seriously and is one of the most hardworking people I know,” says Eliel Arrey. “She sets goals and executes on them. She puts a lot of effort and dedication in all her work. She has never been it for money or fame, she just loves to sing and loves music!” 
​
Nasomi's first taste of fame came in 2012 when one of her underground singles, an original called “Whatever It Takes,” went viral on SoundCloud. Arrey heard the track and got in touch to suggest a collaboration. Today, he is proud to announce the three songs included on “The Essentials,” as well as several other tracks the duo will release later this year.

Since 2011 The “Whatever It Takes” singer-songwriter has performed at various events in the Netherlands and Germany, as well as at the 2012 Esamba Esamba festival in Belgium. “The Essentials” feat. Nasomi by Eliel Arrey is available online for pre-order worldwide now.  

-S. McCauley

Lead Press Release Writer

www.MondoTunes.com

“The Essentials” feat. Nasomi –

https://itunes.apple.com/us/album/the-essentials/id1097226089

Website –

www.elielarrey.com
Download album today
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The Cameroon National Anthem by Eliel Arrey

4/15/2016

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Download track today
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The Essentials - Available Now

4/15/2016

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Music has always been influenced by cultures.   Every society/culture has a unique style to their music and different instruments trademark some cultures. Our album, "The Essentials," is meant to draw music lovers from all backgrounds, cultures, and styles.  Our listeners will sometimes notice our use of a variety of instruments not conventionally used in your everyday music. From Bagpipes playing the African Cameroonian National Anthem, or Kalimbas laying the down the verses in Far Cry, to our rendition of the violins and woodwinds of the Celtic Hills.  The Essentials is going to take every listener on an international journey. We hope that all our listeners can feel and appreciate the diversity we sought after when we compiled this album.  Our vocalists are nothing short of world-class, featuring the powerful Dutch star artist -Nasomi, Salt Lake City's finest -Yolanda, internationally acclaimed songwriter and engineer -Steve Owner, and the extended instrumental rendition of Melissa Otero's "Angels and Demons."  Our listeners will also notice that "The Essentials" contains songs from a variety of genres such as New Age, Modern Classical, Electro House, Dance, Hip-Hop, R&B, Orchestral, and World.  We ourselves had a hard time picking what genre to list the overall album under.  We also pay special tribute to the life and memory of the great movie score composer, James Horner. The entertainment world still mourns the loss of this legend and there exist a void that can never be filled.


Finally,  we love the diversity of the tracks in the project as it symbolizes the diverse influences we have had in our lives and the different cultures that have influence us.  Our goal is that everyone can find something they can relate to when they turn on this album.  So much love and hard work has gone into this project, and it is our deepest honor to share this project with you and the rest of the world.


Sincerely, 


Eliel Arrey & EA Music Group   ​
Download album now
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Hands Up High // Brazil 2014  - single by Eliel Arrey

7/2/2014

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Post by El Arrey.
Tis the season for soccer. Put on your supporter jersey shirts, put on your game face, and put yours Hands Up High, its Brazil 2014.
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Official Reviews of "Taking Me Back" 

9/3/2013

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So as you all know, my track "Taking Me Back" has been a great success all over the internet and I hope for the momentum to continue. Here are the official reviews of the track by some of the best critics and magazines. Names not disclosed. Please feel free to share your thoughts, if you agree with them or not and why. 

Thank you very much for the support. 
REVIEWS


“This song was superb. I really liked the beat and the noise from the piano that was produced. I think the vocalist could be little softer as far as singing goes. The lyrics matched the tone of the music very well I wish there was some more harmony, maybe a second vocalist would be a nice touch to this song.”

“The fermata and the falsetto of the introdcution have a good sytle. I like the tone of the rest in the melody and the compostion. The interval between two notes are good and I like the fifth form of the singer. His pitch is very dynamic and I like the range of his acoustics and the vocalist. The fourth of the fugue and the dynamics of the harmony make a good compostion. The energetic rhythm of the composition and the harmonics are interesting. i like the grave tune and the solo accordance. The impromptu decision of the harmony and the chord progression in the notes and the keys were alright. The hymn and the melody are glissando and the notes are alright.” 

“The intro is just so well performed that it has the biggest impact in the whole song. The tempo goes so well with the vibe of the song and it just makes you want to dance. The most well known artist is the very first to perform and have all of the character just to have a fresh, and original sound just to make the whole song very unique. The upbeat that they used in all of the verses and choruses are so wonderful and outstanding just to make the whole entire song just, more enjoyable and sound with a dynamic and with a lot of emotion relaxing. The challenging and creative side of the song is the instrumental, with the most wonderful background just to make the song very sunny. They have all of the right rhythm in there to not let the song get out of the right pitch. The artist has the greatest and most tuning natural voice that just makes him sing all of thosehighnotes.” 


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New Music, New Artist: I'm In (Class of 2017) - feat. Fryonic

6/18/2013

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Today ELIEL ARREY announced the release of 2 new tracks. The project is called "I'm In (Class of 2017)."  Eliel Arrey states that the project was inspired and dedicated to all medical students who graduate in 2017, including Eliel Arrey himself at Medical Student at University of Texas at Houston. 

Above all, the project unveils the curtains and introduces a rising band from Nevada called Fryonic. With a very stable and dedicated following on sound cloud, Fryonic is now taking their music to the next level. Fryonic is a musical duo from Las Vegas. Ryan (Mike) Francis and Rayvindu (Ray) Perera work hard to combine an urban sound, metal influences, and an electronic music base into an amazing audio hybrid. They pride themselves in creating music for intellectual crowds and will continue to provide the intense experience their music provides. Click here for more about Fryonic.

 Fryonic's remix of the track "I'm In (Class of 2017)" will be available in stores on July 12th, 2013 worldwide for convenient download under the label Mondotunes. 


Listen to an Exclusive Preview available on Jango Radio

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New Spotify Exclusive track by ELIEL ARREY - 5ive (Radio Edit)

6/6/2013

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Eliel Arrey's new track called "5ive" is now available as a Spotify exclusive. 


5ive is the first track unveiled to the world from the highly anticipated album by Eliel Arrey due for release next year. 


Eliel Arrey has announced that his debut album next year will have over 20 tracks and will also be available for physical distribution.


Listen to "5ive" for free at no charge and share with all your friends.

Best,

EA Music Group
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This Summer's biggest hit: Night in Stockholm

5/21/2013

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The digital music disc jockey known as DJArrey has released his new dance single, titled, “Night in Stockholm,” to broad fan and critical acclaim. The song is a melodic, synth-driven single with digitally orchestrated back beats and a bevy of striking effects. Its main chord progression is fun, catchy and powerful in its fugue-like presentation, very well implemented and as excellent for dancing in underground music clubs on Friday night as it is for night drives through the city. A song in the tradition of house music, it is unique in its subtler use of percussion, a style not often utilized in the subgenre of electronica music.

These traits set “Night in Stockholm” apart from many other dance singles, which is partially what DJArrey has been known for in his music. Arrey has been recognized for instrumentation that may include such unlikely elements as guitars, flutes, saxophones, and other brass instruments in his pieces. This highly personalized style of music production likely has its roots in West Africa, which is where DJArrey first grew up.

Arrey was born and raised in Cameroon. His first musical stint was as a performer in an a-cappella boys' group at the age of 12. He sang in this capacity for four years. In addition to being rated the #2 dance artist on Reverbnation.com, he is also studying to be a medical doctor with his graduation date set for 2017. At University of Texas, Arlington, he also is the founder and president of “Get More Out of College,” a non-profit institution providing free resources to college students worldwide who are studying the biological sciences.


Upon being asked what inspires him to create upbeat, delightful tracks like “Night in Stockholm,” Arrey says simply, “Making music ignites my spirit and reminds me of the beauty of life.”


“Night in Stockholm” is available online worldwide.

-S. McCauley

Staff Press Release Writer

MondoTunes


The single “Night in Stockholm”  is distributed globally by MondoTunes ( HYPERLINK "http://www.MondoTunes.com/" \n _blankwww.MondoTunes.com) and is available at iTunes for convenient purchase and download


MondoTunes ( HYPERLINK "http://www.mondotunes.com/"www.mondotunes.com) supplies the largest music distribution in the world and provides upstream services for many major labels in search of breakout artists. While most independent distributors reach only 45-50 retailers despite charging needless monthly and yearly fees, MondoTunes reaches over 750 retailers and mobile partners in over 100 world regions without any monthly or yearly fees.

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