Discussion Post: Improving The Value of Healthcare

Discussion post: Improving the Value of Healthcare

High value healthcare entails the dimensions of cost containment, patient safety, patient satisfaction and patient outcomes. The National Academy of Medicine defines high-value healthcare as safe, timely, effective, efficient, equitable, and patient-centered (STEEEP) (Smith, 2020). The term Quadruple Aim is used by the Institute for Healthcare Improvement (for lower costs, enhanced patient satisfaction, healthcare workers welfare, and improved patient outcomes) (Smith, 2020)Discussion Post: Improving The Value of Healthcare.

Value-based payment is a system of compensation whereby insurance providers reimburse healthcare providers for the quality of service availed to clients. The value of healthcare is determined by outcomes and safety, divided by cost of care provision. Therefore, providers seek to add value to healthcare via lower costs and improved safety and care outcomes (Teisberg, 2020).

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Public reporting is required of all hospital networks and typically used to facilitate comparison between plans. The National Committee for Quality Assurance (NCQA) provides reporting requirements for HMOs and PPOs on numerous parameters (Kleinpell & Kapu, 2017). For example, the performance of a healthcare facility is publicly reported on and used to rank the facility in the safety dimension of care. In terms of performance measurement, there are standard indicators provided by the Agency for Healthcare Research and Quality (AHRQ) (Kleinpell & Kapu, 2017). Performance measures include patient safety indicators, inpatient indicators, and prevention indicators.

As to payment, the primary types of payment plans are value-based payments and fee-for-service. The value-based system employs risk-bearing population wide contracts, which provide incentive to lower costs of healthcare provision and improve quality of service (Werner, 2021). The fee-for-service payment system is volume based and motivates hospitals to provide as many services as possible as often as possible at prices determined by competition and resource-based factory. In my professional experience, I think fee-for-service payment plans are associated with high quality of service but with the shortcoming of very high costs. There is also no incentive for cost reduction as the burden of costs can easily be shifted to payers. As for value-based plans, I think there’s drive to lower costs, but with limited capacity to improve quality and minimize disparities in healthcare delivery.

Delivery of healthcare impacts quality of care in three notable ways: waste, missed opportunities, and errors (Lakdawalla et al, 2018). These respectively result in overuse, underuse, and errors. In overuse, care interventions are provided when the potential for harm outweighs benefit, for example over-prescription. In underuse, care is not provided when it should be. For errors, the appropriate type of care is provided, but with the outcome of preventable harms such as hospital acquired infections. Notably, payment systems and care delivery processes need constant monitoring and evaluation to facilitate improvement in quality of care.

References

Kleinpell, R., & Kapu, A. N. (2017). Quality measures for nurse practitioner practice

evaluation. Journal of the American Association of Nurse Practitioners, 29(8), 446-451.

Lakdawalla, D. N., Doshi, J. A., Garrison Jr, L. P., Phelps, C. E., Basu, A., & Danzon, P. M.

(2018). Defining elements of value in health care—a health economics approach: an ISPOR Special Task Force report [3]. Value in Health, 21(2), 131-139.

Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based

health care: a strategic framework. Academic Medicine, 95(5), 682.

Smith, M. T., (2020). What is value-based care? These are the key elements. [online] Discussion Post: Improving The Value of Healthcare

American Medical Association. Available at: <https://www.ama-assn.org/practice-management/payment-delivery-models/what-value-based-care-these-are-key-elements> [Accessed 2 August 2022].

Werner, R. M., Emanuel, E. J., Pham, H. H., & Navathe, A. S. (2021). The future of value-

based payment: A Road Map to 2030. Discussion Post: Improving The Value of Healthcare