Value-based Care Flashcards
How do we define value?
- cost effectiveness
- biggest bang for the buck
- individual and community priorities
- value = outcomes/cost
What are some value based care outcomes?
- emergency room utilization
- antidepressant continuation
- antidepressant initiation
- initiation of alcohol and other drug dependence treatment
What are QALYs and DALYs?
Quality adjusted life years and disability adjusted life years
What is fee for service?
Every visit, test, devise, and encounter was paid for separately
Also known as retrospective payment system
What was the problem with fee-for-service?
Incentives overutilization of care
What did Medicare Part A start using to control spiraling hospital costs?
Prospective payments
What is a diagnosis related group?
Something that dictates reimbursement based on diagnoses, procedures, and case complexity
Health care is moving away from paying for volume, and insurers are redesigning payments to incentivize ____ care
High quality, cost-effective
What are the incentives for value based care?
Bonuses or penalties based on performance
What are some quality measures?
- readmissions
- improvement over time
- cost savings
- possible focus on certain patient populations
Are value-based payments supported by the data?
Not really
Value-based payments are also referred to as ____
Alternative payment models (APMs)
What are the three APMs?
- pay for performance
- bundled payments
- capitation
What is pay-for-performance?
Providers are rewarded or penalized based on whether they meet pre-determined quality benchmarks
What are bundled payments?
Providers receive a lump sum per episode and usually are rewarded through cost savings
What is capitation? Who uses it?
Providers agree to coordinate care and meet quality benchmarks for a specified patient population, often per member per month fee
Medicare and Medicaid do this
What is one-sided vs two-sided risk?
One sided: providers can only gain
Two-sided: providers may also lose
What are Accountable Care Organizations (ACOs)?
- a payment model for primary care delivery
- groups of providers agree to treat a set population in exchange for PMPM payments
- value derived from cost savings, incentivizing preventative services and care coordination
What are the effects of value based care on an organizational level?
- develop team based approaches between primary care and specialty care
- expanded options for patients
- increased importance of data and data analysis
- conflicting incentives of fee-for-service and value-based contracts
- mergers and alignment to gain a sense of “safety in numbers”
What are the effects of value-based care on the provider level?
- increase productivity, not necessarily payment
- more task delegation
- more admin burden
What are the issues with value-based care?
- inadequate care delivery due to different health record systems, inefficient points of access, and inability to make micro adjustments
- distorted incentives like kicking patients who miss an appointment because it costs them their evaluation
- errors in data integrity
- uncontrollable events that compromise prospective payment like new drugs
What are social determinants of health?
Societal and environmental conditions
- food
- housing
- transportation
- education
- violence
- social support
- health behaviors
- employment
