An Example of Translating Value-Based Purchasing Into Value-Based Care

Aroh, Dianne; Colella, Joan; Douglas, Claudia; Eddings, Ashley

doi:10.7257/1053-816x.2015.35.2.61

Cited by 12 publications

(4 citation statements)

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“…Nursing has a unique opportunity to align with the tenets of health care reform and lead this health care transformation. 5 To ignite these changes, nurses from leadership to frontline staff must embrace innovations to deliver care that supports the Triple Aim. 3…”

Section: Value-based Care Briefmentioning

confidence: 99%

“…4 This fundamental reform legislation created a paradigm shift from a volume focus, where providers were rewarded for the number of tests or procedures performed to a value-based structure that incentivizes providers to deliver quality at a reduced cost. 5 This paradigm shift from volume to value is a call to action for nursing. Salmond and Echevarria 3 highlight the importance of nursing as a critical player in this health care transformation.…”

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confidence: 99%

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Value-Based Care

Huffman¹

2021

Nurse Leader

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In today's challenging health care environment, the paradigm shift from volume to value requires nurse leaders to develop enhanced skills to transform health care in 2020. Key drivers for success include: igniting innovation and change; embracing data and analytics; and launching new care delivery models that soar beyond organizational boundaries. Value-based care is here to stay, and nursing must be the catalyst for change. Equipped with new skills and the knowledge of CMS Pay for Performance programs, nurse leaders will design the future health care landscape.

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Section: Value-based Care Briefmentioning

confidence: 99%

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confidence: 99%

Value-Based Care

Huffman¹

2021

Nurse Leader

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“…Ibe and colleagues showed in their study that purchasers (insurers) as public representations for health service purchasing use effective mechanisms for determining and reflecting public needs and priorities that results in monitoring the communication process between themselves and providers as well as by contacting and the payment mechanisms [ 23 ]. Aroh and colleagues revealed in their study that strategic purchasing has changed into a framework for the purchasers of health care in order to consider the high-quality and affordable service delivery [ 24 ]. However, Hagenaars and colleagues showed in their study that more active purchasing patterns in health systems make them more complex and can increase administrative burden [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting health services strategic purchasing for breast cancer patients: a mixed study in Iran

Yaghoubian¹,

Jahani

Farhadi

et al. 2021

Cost Eff Resour Alloc

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Background Inappropriate ways of health services purchasing for cancer patients can be challengeable and costly and seriously affect the access to health services and outcomes. This study aimed at Factors affecting health services strategic purchasing for breast cancer patients. Methods As a mixed study, this research was conducted in Iran in 2020. In the qualitative phase, 21 specialists and professionals in the field of health services purchasing were purposefully selected and interviewed. After data saturation, interviews were analyzed with the framework analysis and a structured questionnaire was made based on these analyses. 400 breast cancer patients were selected by randomized sampling and completed the questionnaire. Data were analyzed with SPSS23 in p < .05. Results The highest mean rate of the three main categories belonged to “insurance trusteeship” (4.71 ± .35), followed by “supply management” (4.48 ± .27) and “financial performance” (4.48 ± .37). There were significantly differences between the mean rates of the main categories and the cut-off point (p < .001). In addition, “insurance trusteeship” ranked first (2.58), followed by financial performance (1.77) and supply management (1.65). Conclusion Of main components in health services strategic purchasing for breast cancer patients, insurance trusteeship, supply management, and financial performance ranked first to third, respectively. Therefore, healthcare policy-makers should consider the placement of insurance trusteeship and coordinate between purchasers and providers for making reform in the health system.

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“…This shift equates to insurers such as Medicare to reward or penalize hospitals based on patient care and process outcomes. The HVBP recognizes providers who deliver better outcomes at lower costs (Aroh et al, 2015;Figueroa et al, 2016;Haley et al, 2017). With HVBP, hospital performance is based on four quality domains: Person and Community Engagement (25%), Clinical Care (25%), Safety (25%), and Efficiency and Cost Reduction (25%; CMS, 2018a).…”

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Quality Improvement Essentials

D’Eramo¹

2022

Quality and Safety Education for Nurses

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Undoubtedly, the most important single requisite is a commitment to quality: an unequivocal desire and determination to dedicate oneself to the best one is capable of, despite every obstacle. " -Donabedian, 2003, p. xxix Upon completion of this chapter, the reader should be able to:1. Define quality improvement (QI). 2.Describe the historical evolution of QI. Explain QI in nursing practice 4.Compare and contrast QI, evidence-based practice, and research. 5.Differentiate between QI models and methodologies, including Plan-Do-Study-Act (PDSA), Lean, and Six Sigma. 6.Describe reactive and proactive approaches to QI problems. 7.Explore the role of the nurse in QI projects. 8.Discuss the impact organizational leadership has on QI activities. CROSSWALKThis chapter addresses the following: QSEN Competency: Quality Improvement The American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. Domain 5: Quality and Safety 1. From an interprofessional perspective, who would the nurse initially contact based on this observation? 2. What regulation(s) is the nursing admission assessment policy that stipulates medication reconciliation be conducted on every home visit based on? 3. Is there opportunity to consider a quality improvement activity based on this scenario? DEFINING QUALITY IMPROVEMENT Quality improvement (QI) is defined the same for both prelicensure and graduate nursing education by the Quality and Safety Education for Nurses (QSEN) competency as "Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems" (QSEN Institute, n.d.-a, n.d.-b). The knowledge, skills, and attitudes (KSAs) differ, however, in that the prelicensure expectations focus on preparing the new nurse to participate in or lead small-scale QI activities while graduate students are expected to take a greater role and facilitate QI activities across the organization. QI is the process of collecting and analyzing data to determine the extent to which quality healthcare is being delivered 11: QUALITY IMPROVEMENT ESSENTIALS | 363 according to established standards. Standards may be internal, such as those created by the organization, or external, such as those created by regulatory bodies. QI can be considered as both an art and a science (McLaughlin et al., 2012). Indeed, the art of QI involves asking questions and coming up with creative ideas and visionary innovations of how to approach and consider improvement interventions. The science of QI, presented in Chapter 12, involves the ongoing process of testing improvement interventions, to measure if improvements lead to the intended outcomes, and to sustain intended outcomes.Triggers that may initiate a QI activity may include inconsistent patient outcomes, poor patient outcomes, patient outcomes that do not meet expectations related to evidence-based practice (EBP) or to standards, or patient/family complaints. Such outco...

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An Example of Translating Value-Based Purchasing Into Value-Based Care

Cited by 12 publications

References 2 publications

Value-Based Care

Value-Based Care

Factors affecting health services strategic purchasing for breast cancer patients: a mixed study in Iran

Quality Improvement Essentials

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