Value-based health care

Value-based health care (VBHC) is a framework for restructuring health care systems with the overarching goal of value for patients, with value defined as health outcomes per unit of costs.[1] The concept was introduced in 2006 by Michael Porter and Elizabeth Olmsted Teisberg, though implementation efforts on aspects of value-based care began long before then in the 1990s.[2][3] With patient value as the overarching goal, VBHC emphasis systematic measurement of outcomes and costs, restructuring provider organizations, and transitioning toward bundled payments.[2] Within this framework, cost reduction alone is not seen as proper strategy for healthcare systems: health outcomes have to improve to enhance value.[4][5] Although value-based health care is seen as a priority in many health systems worldwide, a global assessment in 2016 found many countries are only beginning to align their health systems with VBHC-principles.[6][7] Additionally, several studies report incoherent implementation efforts, and there seem to be various interpretations of VBHC, both within and across countries.[8][9]

Description

In a value-based care model, providers would work with patients to determine a treatment plan, then measure the relevant clinical results over the course of the patient's treatment.[4][10][5]

There is debate as to whether patient experience and satisfaction with the quality of their care is a component of value-based care. Some argue that while patient satisfaction is often conflated with value-based care, satisfaction is predicated on the patient's experience of treatment, rather than its medical effectiveness.[5] However, the Agency for Healthcare Research and Quality (AHRQ) states that patient experience is an integral component of healthcare quality, and that patient experience is in fact different from patient satisfaction.[11] There is a relationship between patient experience and greater medical effectiveness associated with patient adherence to medical advice.[12] It is for this reason that patient experience surveys, namely CAHPS surveys, are national reporting requirements for several value-based purchasing programs, such as the Hospital Value-Based Purchasing (VBP) Program.[13][14]

Cost reduction is a component of this model - for example, by making healthcare cost information more readily available to patients - but it may not be the primary goal from a patient perspective, though it may be an important consideration from the perspective of payers, purchasers, and providers with an interest in the promise of maximizing outcomes per unit of cost inherent to VBHC.[4][15]

References
  1. Porter ME (December 2010). "What is value in health care?". The New England Journal of Medicine. 363 (26): 2477–81. doi:10.1056/NEJMp1011024. PMID 21142528.
  2. Porter M (2006). Redefining Health Care. Harvard Business Review Press. ISBN 9781591397786.
  3. "Page 3". www.ahrq.gov. Retrieved 2022-07-26.
  4. Bozic KJ (April 2012). "Value-based healthcare and orthopaedic surgery". Clinical Orthopaedics and Related Research. 470 (4): 1004–5. doi:10.1007/s11999-012-2267-x. PMC 3293948. PMID 22302657.
  5. Teisberg E, Wallace S, O'Hara S (May 2020). "Defining and Implementing Value-Based Health Care: A Strategic Framework". Academic Medicine. 95 (5): 682–685. doi:10.1097/ACM.0000000000003122. PMC 7185050. PMID 31833857.
  6. Kimpen J (12 February 2019). "Here's how to make 'value-based healthcare' a reality". World Economic Forum. Retrieved 2019-08-03.
  7. Shah A (12 May 2016). "Value-based healthcare: A global assessment". Medtronic: Value Based Healthcare. Retrieved 2019-08-03.
  8. Steinmann G, van de Bovenkamp H, de Bont A, Delnoij D (September 2020). "Redefining value: a discourse analysis on value-based health care". BMC Health Services Research. 20 (1): 862. doi:10.1186/s12913-020-05614-7. PMC 7488985. PMID 32928203.
  9. Steinmann G, Delnoij D, van de Bovenkamp H, Groote R, Ahaus K (April 2021). "Expert consensus on moving towards a value-based healthcare system in the Netherlands: a Delphi study". BMJ Open. 11 (4): e043367. doi:10.1136/bmjopen-2020-043367. PMC 8047988. PMID 33846147.
  10. Nilsson K, Bååthe F, Andersson AE, Wikström E, Sandoff M (February 2017). "Experiences from implementing value-based healthcare at a Swedish University Hospital - an longitudinal interview study". BMC Health Services Research. 17 (1): 169. doi:10.1186/s12913-017-2104-8. PMC 5330026. PMID 28241823.
  11. "What Is Patient Experience?". www.ahrq.gov. Retrieved 2022-07-26.
  12. Anhang Price, Rebecca; Elliott, Marc N.; Zaslavsky, Alan M.; Hays, Ron D.; Lehrman, William G.; Rybowski, Lise; Edgman-Levitan, Susan; Cleary, Paul D. (October 2014). "Examining the role of patient experience surveys in measuring health care quality". Medical care research and review: MCRR. 71 (5): 522–554. doi:10.1177/1077558714541480. ISSN 1552-6801. PMC 4349195. PMID 25027409.
  13. "QualityNet Home". qualitynet.cms.gov. Retrieved 2022-07-26.
  14. "Consumer Assessment of Healthcare Providers & Systems (CAHPS) | CMS". www.cms.gov. Retrieved 2022-07-26.
  15. "CMS' Value-Based Programs | CMS". www.cms.gov. Retrieved 2022-07-26.


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