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Affordable Healthcare Act

Measuring Value: Through the Lens of Patients

By | Affordable Healthcare Act, Healthcare Providers, Healthcare Quality, Healthcare Value, Volume-to-Value | No Comments

 

Hospital Value-Based Purchasing (VBP) is Medicare’s payment system to reward providers for the quality of care they provide. This program rewards acute care hospitals with incentive payments for the quality of care they give to patients, not just the quantity of services they provide. The payments are made by asking, “How well did you do? rather than How much did you do?.”

MEASURING VALUE

Management guru Peter Drucker is often quoted as saying that “you can’t manage what you can’t measure.”

The goal of value-based reimbursements is to replace the fragmented, fee-for service care with comprehensive, coordinated care using payment models that holds organizations accountable for cost control and high quality outcomes. The shift from volume to value starts with measurement. Measuring volume is simple, but how do you measure value in health care?

The health care value equation is defined as quality over cost.

TOTAL PERFORMANCE SCORE (TPS)

A hospital’s performance is assessed on the measures that comprise various domains. The domains are weighted and rolled up to the Total Performance Score. The FY 2017 Total Performance Score (TPS) is derived from 4 domains as below:

  1. Clinical Care (30 percent)
    • Outcomes (25 percent)
    • Process (5 percent)
  2. Patient and Caregiver Centered Experience of Care/Care Coordination (25 percent)
  3. Safety (20 percent)
  4. Efficiency and Cost Reduction (25 percent)

INCENTIVE PAYMENT

The Total Performance Score is then translated into an incentive payment that makes a portion of the base Medicare severity diagnosis-related group (MS-DRG) payment contingent on performance. It’s possible for a hospital to earn back a value-based incentive payment percentage that is less than, equal to, or more than the applicable withholding for that Fiscal Year (FY). Following is the withholding schedule:

FY 2013 1.00% FY 2016 1.75%
FY 2014 1.25% FY 2017 2.00%
FY 2015 1.50% Succeeding Years 2.00%

UNIT OF VALUE MEASUREMENT

The data collection and the performance improvement at the hospital level has been challenging, especially with the exponentially increasing metrics used to measure performance. The complexity increases when the unit value of measurement is at the individual provider level.

The next phase in the value transformation will focus on measuring individual provider performance in the delivery of high value care to address the question(s) – “How well did the individual provider do?” and more importantly, “How well did the patient do?”.

FURTHER DISCUSSION

CHI will further explore the evolving definitions of healthcare value at our Healthcare Executive Roundtable Discussion on 10/12/17 in Manhattan, NY. The Roundtable is an expert, cross-sectoral discussion designed to help healthcare stakeholders optimize engagement, communication, and collaboration. The exclusive roundtable provides the top thought-leaders, visionaries, and executives from the patient advocate, provider, biopharma, and payer spaces with the latest insights and ideas on how patient engagement drives healthcare value for all stakeholders. Please visit chisite.org/education/healthcare-executive-roundtable for more information.

The Evolving Role of Healthcare Providers

By | Affordable Healthcare Act, Collaboration, Global Healthcare Trends, Health Insurance, Healthcare Innovation, Healthcare Providers, Patient Engagement, Patient-Driven Healthcare | No Comments

The Evolving Role of Healthcare Providers

We are in an age of healthcare consumerism where patients’ interests are more vested than ever. It’s important for providers to accommodate the power shift. This means increasing transparency, finding new ways to facilitate communication, responding directly to patient concerns and questions when raised, and being proactive in staying ahead with new innovations in health and medicine.

Patients are also now more informed than ever, which has helped to create a competitive atmosphere in the world of healthcare. Patients can compare services and prices, so healthcare providers must be able to meet expectations and show how they will work with patients to achieve the best outcomes. Healthcare providers can no longer afford to stay on the sidelines and wait for patients to interact; they must actively engage patients regularly.

Attracting New Patients

In the past, healthcare providers could depend on word of mouth and a small ad in the local phone book to bring in patients. A passive approach like this will not work anymore. It is imperative for healthcare providers to carefully create and refine their online presence, not only providing basic information, but also working to appeal to patients. Social media interactions and patient testimonials may help to make an office or provider seem more accessible and attractive.

Working with Health Insurance Agencies

Most patients now have health insurance, thanks in part to the Affordable Care Act. It is wise for healthcare providers to work closely with health insurance agencies to create a seamless experience for patients. Being “in-network” will help patients with particular plans learn about healthcare providers. Being knowledgeable about what services will cost patients out of pocket and taking steps to make the claims process simple for patients may help to distinguish one in-network provider from the rest.

Facilitating Meaningful Engagement

There are now many different options for engaging with patients, so sticking to only contacting patients via telephone sends a message that a provider is behind the times or not willing to make an effort to engage patients. Providers should find out patients’ favored method of communication when gathering basic personal and health information and use those methods to communicate regularly between visits. Patients want evidence that their healthcare providers truly care about their health.

Anticipating Future Changes

The healthcare landscape is becoming ever more connected and comprehensive. Taking action to keep up with current industry trends-such as making information easily accessible by other providers during transitions of care and allowing patients to access information online – will help healthcare providers to stay relevant and in business. Since healthcare is rapidly changing, it is also important to stay one step ahead and anticipate future changes so that it is easy to continue to adapt as shifts occur.


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