Value Based Care

Question 1

How is value defined in healthcare?

Answer 1

Value = Quality ÷ Cost, where Quality includes patient experience and outcomes

Question 2

Give examples of:

1) improving outcomes without raising cost,
2) maintaining outcomes while reducing cost
3) improving outcomes with a small raise in cost

Answer 2

1) develop plan for medication compliance
2) prescribe generic medication
3) provide access to at-home equipment

Question 3

When measuring value (specifically, quality), what are examples of outcome measures that may be taken into account, and what shift has taken place with respect to outcome measures?

Answer 3

Survival, Functional Outcomes, Complications

Greater emphasis on Patient Reported Outcome Measures (i.e., what matters to patients)

Question 4

List 4 sources of waste that increase healthcare costs.

Answer 4

Unnecessary services that don’t change outcomes, failure of coordination (e.g., re-ordering a test because you can’t access prior results), administrative costs, and missed prevention opportunities

Question 5

How do fee-for-service (FFS) and bundled payment (BP) models differ? Which model has greater value and why?

Answer 5

FFS – compensation provided for every service provided and patient seen; BP – provides one bundled payment per episode of care that covers all components of patient care

BP has greater value because it incentivizes efforts to reduce waste (e.g., coordination)

Question 6

What is an integrated practice unit (IPU), and what is its key characteristic?

Answer 6

Combines all components of care under one roof, creating a multidisciplinary unit that allows providers to more efficiently coordinate

Puts patient at center of care, NOT the health system

Question 7

What is the full capitation payment model? How does its value compare to FFS and BP?

Answer 7

The healthcare organization (e.g., Oak Street Health) assumes full financial responsibility for all components of patient care, including clinic visits, testing, ER visits, and post-acute care; has greatest value

If they do more than what the insurance pays them monthly, they assume responsibility for the cost, which incentivizes them to reduce cost so that they can turn a profit