Case 4: Value-based health systems Flashcards
(60 cards)
1
Q
What is the definition of value?
A
Multiple definitions:
- patient health outcomes achieved per dollar spent.
- health outcomes achieved that matter to patients relative to cost of achieving those outcomes
2
Q
What is the problem with the definition of value saying “Value → patient health outcomes achieved per dollar spent”?
A
- limitations in context of UHC systems funded through social insurance or taxation.
- Focusing only on funds spent on each patient’s cycle of care doesn’t take account of available resources & how they are allocated across population
3
Q
What are the current issues with value?
A
- difficult to measure & deliver value
- Providers measure only what directly control in intervention & what is easily measured, instead of what matters for outcomes
- no clear definition
4
Q
Why do we need to consider value in HC?
A
Resources are increasingly outstripped by demand for HC. driven by:
- changing population demographics
- innovation & new technologies
- patient expectations
- increase in multi-morbidity.
5
Q
How do we measure value?
A
- measured by outcomes achieved, NOT by # of services delivered or by process of care used.
- Health status achieved
- Nature of care cycle and recovery
- Sustainability of health
6
Q
What are the 3 tiers in the 3 tiered hierarchy of outcomes?
A
- tier 1 - health status achieved or retained
- tier 2 - process of recovery
- tier 3 - sustainbility of health
7
Q
Explain the tier 1 of the hierarchy of outcome measurement
A
health status achieved or retained
first level = survival of the health issue
second level = degree of health recovery → most important tier
8
Q
What are the trends in health & healthcare?
A
- From treatable → preventable
More attention to:
- prevention relative to treatment
- QoL than extending life expectancy
- shared decision making & value for patients: patient centred care, not physician centred care
9
Q
Why are HC systems so inefficient & not patient centered?
A
- Practice variation
- Overtreatment
- Administrative costs
→ root cause: payment NOT based on patient values
10
Q
What are the reasons for practice variation & overtreatment?
A
- Payment is not based on what patients value
- Fee-for-service payment systems
- Rewards quantity, not quality
- Incentive to perform more interventions
11
Q
What is fee-for-service (FFS)?
A
method where HC providers are paid for each service performed. E.g. of services include tests & office visits.
12
Q
What are the advantages of FFS?
A
- Incentive for productivity
- Financial recognition for achievement and effort
13
Q
What are the disadvantages of FFS?
A
- Incentive to perform as many medical interventions as possible (unnecessary interventions)
- Incentive to carry out treatment yourself and not to refer patients to medical specialist (no optimal treatment) - make more money yourself as practitioner
- Quantity is rewarded, not quality
14
Q
What is VBHC?
A
“equitable, sustainable & transparent use of available resources to achieve better outcomes & experiences for every person”
15
Q
delete
A
deletde
16
Q
By focusing on health outcomes, what does VBHC do?
A
- helps HC providers manage cost increases
- make the best use of finite resources
- deliver improved care to patients.
17
Q
What are unwarranted variaitons in HC?
A
Differences in… that aren’t explained by patient preference or illness:
1. resource allocation
2. resource use
3. outcomes in health
- Associated with overuse/underuse of health technologies & care
18
Q
What can unwarranted variations show?
A
- where resources might be wasted
- underuse or overuse of care
- opportunities to increase value.
19
Q
What are the types of value based payment models?
A
- Bundled payments
- Pay-for-performance
- shared savings
- shared risk
- Global capitation
20
Q
Explain bundled payments as a value based payment model
A
- fee for period of care instead of paying for each individual service delivered in the care cycle
- Can be combined with shared-savings or shared-risk components
21
Q
Explain pay-for-performance as a value based payment model
A
- often implemented together with FFS payments, to make more value-based.
- payments reward HC providers with added bonuses if they achieve specific targets set by payers for quality and costs of care.
22
Q
Explain shared risk as a value based payment model
A
providers share financial risk with payers based on predefined quality & cost targets
23
Q
Explain shared savings as a value based payment model
A
providers receive a share of cost savings achieved by delivering high-quality care at a lower cost
24
Q
How can we transform into value-based systems?
A
- VBHC model requires paradigm shift from supply-driven HC system organised around what physicians do → patient-centred system organised around what patients need.
- Shift focus from volume & profitability of services provided → patient outcomes achieved
- 6 elements of patient value model from Porter
25
What are 5 provider behaviours that boost HC value?
| see image doc
1. Engage patients so they play more active role in choice & decisions that shape their health.
2. Prioritise wellness & disease prevention
3. Deliver high-quality, appropriate care
4. Embrace continuous improvement & clinical innovation
5. Do all this whilst also managing total costs of system.
26
What 6 elements help to support transition from volume-based to a value based system?
| see image
1. Organise into integrated practice units (IPUs)
2. Measure outcomes & costs for every patient
3. Move to bundled payments for care cycles
4. Integrate care across separate facilities
5. Expand geographic reach
6. Building an enabling IT platform
27
Explain **"organise into IPUs"** as one of the 6 components of a high-value HC system
* Clearly defined patient groups since relevant outcomes differ between groups
* Organising around patient’s medical conditions rather than physician’s medical specialities
28
What are IPUs?
multidisciplinary team organised around medical condition/ set of closely related conditions that regularly meets to discuss care plans for patients along the full care cycle
29
Explain **"measure outcomes & costs for every patient"** as one of the 6 components of a high-value HC system
● Health outcomes are what patients find important
● Costs are the fee for all providers throughout the care cycle
30
Explain **"move to bundled payments for care cycles"** as one of the 6 components of a high-value HC system
* Efficient financing reducing costs
* “Bundled payments is the preferred payment model to increase value”
31
Explain **"integrate care across separate facilities"** as one of the 6 components of a high-value HC system
Interacting and cooperation of care providers (GP, hospital and radiologist)
32
Explain **"expand geographic reach"** as one of the 6 components of a high-value HC system
Willingness for providers to utilise new practices developed elsewhere
33
Explain **"build an enabling IT platform"** as one of the 6 components of a high-value HC system
Methods to collect, measure, report and analyse outcomes frond data
34
What are the 4 pillars of value?
1. Technical value
2. Allocative value
3. Personal value
4. Societal value
35
Explain **technical value** as one of the 4 pillars of value
achievement of best possible outcomes with available resources
36
Explain **allocative value** as one of the 4 pillars of value
equal distribution of resources across all patient groups
37
Explain **personal value** as one of the 4 pillars of value
appropriate care to ahcieve each patients personal goals
38
Explain **societal value** as one of the 4 pillars of value
contribution of HC to social participation & connectedness
39
What are the 4 domains of the adoption of VBHC?
1. Enabling context of policy & institutions for value in HC
2. measurement of outcomes & costs
3. Integrated & patient-focused care
4. Outcome-based payment approaches
40
What are enablers of VBHC?
● **Government intervention**: VBHC can't be implemented by providers alone & should be supported/rewarded by governments
● **Focus on IT improvements**: improve electronic communication & integrate IT in full cycle of care
● **Institute VBHC culture among providers:** foster culture and behaviour within health organisation to increase willingness to adopt VBHC → also prevents top-down implementation
41
Explain tier 2 of the hierarchy for outcome measurement
outcomes related to the **recovery process**
→ first level = time required to recover r & return to normal function
→ second level = disutility of care or treatment process (discomfort, complications, ineffective care etc.)
42
Explain tier 3 of the hierarchy of outcome measurment
sustainability of health
→ first level = recurrence of original disease or long-term complications
→ second level = captures new health problems as a consequence of treatment
43
What are payment systems for physicians?
1. fee for service
2. capitation
3. salary
44
What is capitation?
fixed amount per patient irrespective of amount of treatment
45
What are the advantages of capitation?
* Simple administration
* Beneficial for GPs
* Easier for budgeting & preferred by governments & insurers
46
What are the disadvantages of capitation?
Incentive to collect as many patients as possible & refer to specialists quickly to perform as little interventions possible
47
What is salary?
Amount per working hour
48
What are the advantages of salary as a payment system for physicians?
* Easiest system for administration
* Easiest system for budgeting
49
What are the disadvantages of salary as a payment system for physicians?
* No incentive to supply sufficient effort in work since your paid anyways
* Incentive to refer to specialists quickly
* No sense of reward
50
What do the payment systems for physicians have in common?
* Focus on the quantity of care instead of the quality
* Some incentives produced are not desirable for patients
51
Why is health spending per capita increasing?
due to ageing populations & costly medical interventions → more spending does not equate to improved health
52
What are consequences of VBHC?
● More patient-relevant outcome measures
● Integrated networks of care & more collaboration between different providers
● More use of data and advanced IT systems
● Embraces a shared decision making process
● Emergence of value-based payment models
53
Explain the domain **enabling content, policy & institutions for value in HC**
Countries need ecosystem of institutional & policy structures that support value-based approached → lack national-level policy makers
54
Explain the domain **measuring outcomes & costs**
● Data & measurement allows for ability to conduct costbenefit analyses & monitor outcome data
● Transparent healthcare pricing/increasing demand of electronic health records
55
Explain the domain **integrated and patient-focused care**
Integrated instead of siloed, fee-for-service care generates efficiency & reduces waste of resources but require interoperable IT systems
56
Explain the domain **outcome-based payment approach**
* Bundled payment cover end-to-end procedures
● Mechanisms for withdrawing resources from treatments, drugs and interventions that are not cost-effective
● Health expenditure is a strong indicator of VBHC
57
What are barriers of VBHC?
* lack of data registries
* no evidence-based approach
* multi stakeholder involvement
* no value-based culture
* risk averse nature of providers
58
What are the priorities of value in health systems?
* health improvement
* responsiveness
* financial protection
* efficiency
* equity
59
What are value based payment models?
models that reinforce VBHC, often rewarding providers with bonus when they meet predefined thresholds for quality care
60
What are barriers for value-based payment models?
* administration
* multistakeholder
* no data
