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Value-Based Care

Value-Based Care

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Value-Based Care

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  1. Value-Based Care Value-Based Quality & Safety Lecture a - Overview This material (Comp 23 Unit 5) was developed by the University of Alabama at Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0007. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit

  2. OverviewLearning Objectives • Define quality, patient safety, and value of care • Identify current gaps in health quality • Discuss how health care quality is a foundation for value based care • Discuss the financial imperative of value based care • Describe the reasons for the shift to value based care models

  3. Healthcare Quality • Institute of Medicine (IOM) “Safe, effective, patient-centered, timely, efficient and equitable” • Agency for Healthcare Research and Quality (AHRQ) “Doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results” Source: (IOM, 2001 AHRQ, 2009)

  4. Quality is Multifaceted

  5. Patient Safety • Focus of 1999 IOM report • 8th leading cause of death in the US • IOM definition of safety • “… freedom from accidental injury” Source: (Reason, 1990; IOM, 1998) Image Source: (IOM, 1999)

  6. Error • “failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” • “…. errors depend on two kinds of failures: • Either the correct action does not proceed as intended (an error of execution) • The original intended action is not correct (an error of planning)

  7. Value of Care • “A measure of a specified stakeholder’s preference-weighted assessment of a particular combination of quality and cost of care performance” • Value = Quality outcomes/ Cost • Quality Outcomes • Health outcomes • Increase in safety or error reductions • Excellence in service Source: (NQF, 2009)

  8. US Healthcare Quality • US highest in healthcare spending among industrialized nations • 2 trillion/year • Worse health outcomes than other similar countries • Worse for health equity, efficiency, healthy lives Source: (The Commonwealth Fund, 2014)

  9. Types of Quality Gaps • Underuse • Patients not receiving the care they require • Misuse • Medication error & patient harm • Overuse • Receiving unnecessary care

  10. Gaps in Quality • Appropriate, evidence-based care is given only 55% of the time • 91,000 Americans die each year because they don’t receive appropriate evidence-based care • Nearly 90,000 people die every year, at least in part because they obtain an infection while in the hospital Source: (NCQA, 2004)

  11. Gaps in Patient Safety • Errors cost $29 billion every year • Deaths from medical errors may be even higher • System breakdown Source: (Reason, 1990; IOM, 1998) Image Source: (IOM, 1999)

  12. Americans DesireQuality & Value in Healthcare • 96% of Americans feel it is important to have information about the quality of care • 89% want information about the costs of care • 85% want public and private payers to reward high quality doctors and hospitals Source: (Council of State Governments, 2009)

  13. The “Triple Aim” Source: (Berwick, Nolan & Whittington, 2008)

  14. Domains for Value-Based Care Performance Measurement • Integration of the Triple Aim: • Health outcomes important to populations • Health status/health-related quality of life • Health outcomes (e.g. mortality) • Cost & resource use • Total costs per patient/procedure • Patients’ care experience • Care experience surveys (HCAHPS) Source: (Stiefel & Nolan, 2012)

  15. Key Factors for System of Quantifiable Data • Define specific population • Define metrics • Outcome and process measures • Population and project measures • Gather longitudinal data • Access benchmark or comparison data Source: (Stiefel & Nolan, 2012)

  16. Integrated System of Care • Integrated Practice Units (IPUs) • Outcomes and costs • Bundled payments • Integrate care delivery • Expand service area • Information Technology platform Source: (Porter & Lee, 2013)

  17. Value-Based Purchasing:Linking Payment to Quality “”A major, overarching theme in the Affordable Care Act is one of measurement, transparency, and altering payment to reinforce, not simply volume of services, but the quality of the effects of those services. Instead of payment that asks, “How much did you do,” the Affordable Care Act clearly moves us toward payment that asks, “How well did you do?” and, more important, “How well did the patient do?” That idea is at the heart of Value-Based Purchasing. It is not just a CMS idea; it is one increasingly pervading the agenda of all payers.” Source: (Don Berwick, CMS, 2011)

  18. Value-Based Care:CMS Initiatives • Hospital Readmission Reduction Program • Value-Based Purchasing Program • Hospital Acquired Conditions Program • End-Stage Renal Disease Quality Initiative Program Source: (CMS)

  19. Old Payment Model: Fee for Service • Payment for volume not value • Less coordination • Incentives for duplication • Stifles innovation • Effective management of patient comorbidities

  20. New Payment Model: Pay for Performance (P4P) • Reimbursement incentives for quality, effectiveness, and efficiency • Removes incentives for more services • Data driven • Flexibility for providers to customize patient care • Eliminates fragmentation across the continuum of care

  21. Value-Based Care’s Future • Value Modifier Program • Home Health Value Based-Program • Skilled Nursing Facility Value-Based Program • Health Care Transformation Task Force Source: (Finke, 2015)

  22. National Patient Safety Goals • Computerized Physician Order Entry (CPOE) implementation • Standardized disease management protocols • Communication skills training • Identification and reporting near misses Source: (The Joint Commission, 2015)

  23. Value-Based Quality & Safety Summary – lecture a • The intersection between safety and quality optimizes care. • Value in healthcare is patient outcomes / cost. • The triple aim serves as a foundation of value based care. • Significant financial incentives are attached to quality outcomes. • The industry’s future lays in delivering “value driven healthcare”

  24. Value-Based Quality and Safety References – Lecture a References Agency for Healthcare Research and Quality (AHRQ). Understanding health care quality. (July 26, 2006). CMS. Council of State Governments/Eastern Regional Conference, 2009 Finke D, 2015. All signs point to value-based care: Are you ready? Healthcare Finance News. Institute of Medicine (IOM), 2001. Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: National Academies Press. McGlynn E.A., S.M. Asch, J. Adams, J. Keesey, J. Hicks, A. DeCristofaro, and E.A. Kerr. June 2, 2003. The quality of health care delivered to adults in the United States. New England Journal of Medicine 348 (26): 2635-45. Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, Commonwealth Fund National Committee for Quality Assurance (NCQA), The essential guide to health care quality, National Committee for Quality Assurance (NCQA). 2004. State of health care quality 2004. Washington, D.C.: National Committee for Quality Assurance. National Quality Forum (NQF). Measurement Framework: Evaluating Efficiency Across Patient-focused Episodes of Care. Washington, DC: NQF, 2009.

  25. Value-Based Quality and Safety References 2 – Lecture a References Porter & Lee, 2013, Why Health Care Is Stuck – And How to Fix It. Harvard Business Review. Stiefel, M, Nolan, K. A. Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012. The Joint Commission, National Patient Safety Goals Value Over Volume: Paying for Quality Policy Webinar Series – Wednesday March 28, 2012 Images Slides 5, 11: IOM. To Err Is Human: Building a safer health system Report Cover. Available from: Slide 13: Triple Aim. Collaborative Family Healthcare Association. Used with Permission.

  26. Value-Based CareValue-Based Quality & SafetyLecture a This material was developed by the University of Alabama at Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0007.