Value Based Purchasing
Two formulas V=Q/C Value equals quality divided by cost O=S+P Outcome equals structure plus process
V=Q/C What is value in health care? How is Quality measured? How are Costs measured? Is our current system delivering value to those that require services?
Quality Does our heath care system provide the attributes that people desire in their care? When sick When well
Sick Care What do people want? 1 Don’t kill Don 2 Don’t hurt Don 3 Reduce Don’s pain 4 Don’t make Don feel helpless 5 Don’t make Don wait 6 Don’t waste Don’s money (See “my right knee” on YouTube, also Annals of Internal Medicine 2005)
So, how are we doing with Sick Care? 98,000 deaths annually as a result of medical error** Rate of adverse events in hospitalized patients 2.9-3.7% of patients** 36% of patients complain of inadequate pain control* 55.4% of patients felt their wishes were not adequately considered* 38.5% felt it took too long for their call light to be answered* $19.5 Billion in costs due to medical error ** ** IOM 1999 *NRC Picker 2015 teaching hospital average
Wellness Care What do people want? Disease prevention Health Promotion
So, how are we doing with Disease Prevention?
Adherence to Quality Indicators, Overall and According to Type of Care and Function. McGlynn EA et al. N Engl J Med 2003;348:2635-2645.
So, how are we doing with health promotion? CDC, Behavioral Risk Survey System
OK, we have some opportunities in Quality, what about cost?
Does high quality care necessarily cost more?
Probability of Death for Boys and Men 15 to 60 Years of Age in Sweden, Australia, and the United States, 1970 – 2007. Murray CJ, Frenk J. N Engl J Med 2010;362:98-99.
V=Q/C http://www.brookings.edu/~/media/Research/Files/Reports/2009/8/21-bpc- qualityreport/0821_bpc_qualityreport.PDF
Outcomes = Structure + Process Structure Physical Facilities Equipment People Training Payment Methods Process - Healthcare delivery Diagnosis Treatment Preventive Care Patient Education Measures of Process are nearly equal to measures of quality of care
So what is changing with value based purchasing? Payment Methods Move away from fee-for-service piece work to global fee for population served No additional payment for complications Process Measures Was needed care provided? – reduction of underuse Was care not indicated provided? – reduction of overuse
Current Trials Affordable Care Organizations Patient Centered Medical Homes Giesinger and other large health systems Insurance company trials (inclucing BCBS Kansas City)
Maeng, D. D., Khan, N., Tomcavage, J., Graf, T. R., Davis, D. E., & Steele, G. D. (2015). Reduced Acute Inpatient Care Was Largest Savings Component Of Geisinger Health System’s Patient - Centered Medical Home. Health Affairs , 34 (4), 636 – 644.
Questions?
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