Ledina Lushko’s care outlines the current fragmented nature of the US healthcare delivery system. Johnson Memorial Medical Center (JMMC) must apply methods to improve the integration of care and create value for its patients along the full cycle of care. Ms. Lushko was diagnosed with adrenocortical cancer (CAC) on August 4, 2008. ACC is a very rare cancer that, in most cases is diagnosed only after it reaches an advanced stage. Between July 2008 and November 2009, Ms. Lushko and her family went through a tough period of consulting various doctors (n=16), many tests (200+) and differing opinions from multiple specialists. The care she received was uncoordinated which led to poor medical outcomes (multiple readmissions) and poor patient/family satisfaction. JMMC’s internal analysis regarding the care of Ms. Lushko is outlined below:

Value Chain Component | Value-Creating Strength | Value-Reducing Weakness | Service Delivery, Pre Service | * JMMC widely recognized for oncology outpatient specialty units | * No review of records from Albania | Service Delivery, Point-of-Service | * Oncology specialists with 30 years of experience * Expedited inpatient evaluation | * No collaboration and/or agreement of recommended interventions among physicians. * Repeated diagnostic tests * Admitted to the non oncology specialty floor | Service Delivery, After-Service | * None identified in the case | * Poor discharge processes leading to multiple hospital readmissions * Chemotherapy side effects not closely monitored * Lack of physician coordination of care | Support Activities, Culture | * JMMC physicians reached out to more experienced community physicians | | Support Activities, Structure | * JMMC had multidisciplinary care centers organized by disease | * Fragmented care as evidenced by her seeing 16 physicians at 5