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EPH3021: (Public) Health Care Systems in EU > Case 4: Value-based health systems > Flashcards

Case 4: Value-based health systems Flashcards

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
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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
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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
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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.

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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
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6
Q

What are the 3 tiers in the 3 tiered hierarchy of outcomes?

A
  1. tier 1 - health status achieved or retained
  2. tier 2 - process of recovery
  3. tier 3 - sustainbility of health
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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

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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
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9
Q

Why are HC systems so inefficient & not patient centered?

A
  1. Practice variation
  2. Overtreatment
  3. Administrative costs

→ root cause: payment NOT based on patient values

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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
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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.

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12
Q

What are the advantages of FFS?

A
  • Incentive for productivity
  • Financial recognition for achievement and effort
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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
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14
Q

What is VBHC?

A

“equitable, sustainable & transparent use of available resources to achieve better outcomes & experiences for every person”

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15
Q

delete

A

deletde

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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.
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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
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18
Q

What can unwarranted variations show?

A
  • where resources might be wasted
  • underuse or overuse of care
  • opportunities to increase value.
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19
Q

What are the types of value based payment models?

A
  1. Bundled payments
  2. Pay-for-performance
  3. shared savings
  4. shared risk
  5. Global capitation
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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
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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.
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22
Q

Explain shared risk as a value based payment model

A

providers share financial risk with payers based on predefined quality & cost targets

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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

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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
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25
Q

What are 5 provider behaviours that boost HC value?

see image doc

A
  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
Q

What 6 elements help to support transition from volume-based to a value based system?

see image

A
  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
Q

Explain “organise into IPUs” as one of the 6 components of a high-value HC system

A
  • Clearly defined patient groups since relevant outcomes differ between groups
  • Organising around patient’s medical conditions rather than physician’s medical specialities
28
Q

What are IPUs?

A

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
Q

Explain “measure outcomes & costs for every patient” as one of the 6 components of a high-value HC system

A

● Health outcomes are what patients find important
● Costs are the fee for all providers throughout the care cycle

30
Q

Explain “move to bundled payments for care cycles” as one of the 6 components of a high-value HC system

A
  • Efficient financing reducing costs
  • “Bundled payments is the preferred payment model to increase value”
31
Q

Explain “integrate care across separate facilities” as one of the 6 components of a high-value HC system

A

Interacting and cooperation of care providers (GP, hospital and radiologist)

32
Q

Explain “expand geographic reach” as one of the 6 components of a high-value HC system

A

Willingness for providers to utilise new practices developed elsewhere

33
Q

Explain “build an enabling IT platform” as one of the 6 components of a high-value HC system

A

Methods to collect, measure, report and analyse outcomes frond data

34
Q

What are the 4 pillars of value?

A
  1. Technical value
  2. Allocative value
  3. Personal value
  4. Societal value
35
Q

Explain technical value as one of the 4 pillars of value

A

achievement of best possible outcomes with available resources

36
Q

Explain allocative value as one of the 4 pillars of value

A

equal distribution of resources across all patient groups

37
Q

Explain personal value as one of the 4 pillars of value

A

appropriate care to ahcieve each patients personal goals

38
Q

Explain societal value as one of the 4 pillars of value

A

contribution of HC to social participation & connectedness

39
Q

What are the 4 domains of the adoption of VBHC?

A
  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
Q

What are enablers of VBHC?

A

● 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
Q

Explain tier 2 of the hierarchy for outcome measurement

A

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
Q

Explain tier 3 of the hierarchy of outcome measurment

A

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
Q

What are payment systems for physicians?

A
  1. fee for service
  2. capitation
  3. salary
44
Q

What is capitation?

A

fixed amount per patient irrespective of amount of treatment

45
Q

What are the advantages of capitation?

A
  • Simple administration
  • Beneficial for GPs
  • Easier for budgeting & preferred by governments & insurers
46
Q

What are the disadvantages of capitation?

A

Incentive to collect as many patients as possible & refer to specialists quickly to perform as little interventions possible

47
Q

What is salary?

A

Amount per working hour

48
Q

What are the advantages of salary as a payment system for physicians?

A
  • Easiest system for administration
  • Easiest system for budgeting
49
Q

What are the disadvantages of salary as a payment system for physicians?

A
  • No incentive to supply sufficient effort in work since your paid anyways
  • Incentive to refer to specialists quickly
  • No sense of reward
50
Q

What do the payment systems for physicians have in common?

A
  • Focus on the quantity of care instead of the quality
  • Some incentives produced are not desirable for patients
51
Q

Why is health spending per capita increasing?

A

due to ageing populations & costly medical interventions → more spending does not equate to improved health

52
Q

What are consequences of VBHC?

A

● 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
Q

Explain the domain enabling content, policy & institutions for value in HC

A

Countries need ecosystem of institutional & policy structures that support value-based approached → lack national-level policy makers

54
Q

Explain the domain measuring outcomes & costs

A

● Data & measurement allows for ability to conduct costbenefit analyses & monitor outcome data
● Transparent healthcare pricing/increasing demand of electronic health records

55
Q

Explain the domain integrated and patient-focused care

A

Integrated instead of siloed, fee-for-service care generates efficiency & reduces waste of resources but require interoperable IT systems

56
Q

Explain the domain outcome-based payment approach

A
  • 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
Q

What are barriers of VBHC?

A
  • lack of data registries
  • no evidence-based approach
  • multi stakeholder involvement
  • no value-based culture
  • risk averse nature of providers
58
Q

What are the priorities of value in health systems?

A
  • health improvement
  • responsiveness
  • financial protection
  • efficiency
  • equity
59
Q

What are value based payment models?

A

models that reinforce VBHC, often rewarding providers with bonus when they meet predefined thresholds for quality care

60
Q

What are barriers for value-based payment models?

A
  • administration
  • multistakeholder
  • no data

EPH3021: (Public) Health Care Systems in EU (7 decks)

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