The role of Modeling and Simulation in coordination of health care

US healthcare, the most expensive in the world, has been diagnosed as an assemblage of uncoordinated component systems embedded in a market economy that promotes independent pricing with few points of global control over delivered quality of care and cost. Stimulated by the Affordable Care Act and other initiatives, efforts are underway to increase the level of information technology (IT) to improve patient record keeping and portability as well as to price services based on performance rather than amount provided. Yet such an IT infrastructure by itself will not provide significantly greater component coordination since it does not provide transparency into the threads of transactions that represent patient treatments, their outcomes, and total costs. In the traditional formulation of the coordination problem, the goal of the system-of-systems conflicts with those of its components. In contrast, our concern here is the coordination of activities among disconnected provider systems to deliver the appropriate services to an individual client. In this paper, we discuss the Pathways Coordination model, a generic construct that enforces threaded distributed tracking of individual patients experiencing certain pathways of intervention, thereby supporting coordination of care and fee-for-performance based on end-to-end outcomes. DEVS-based Modeling and Simulation methodology is discussed as the means to design, simulate, and implement such client-based coordination in systems engineering.