Value-Based Provider Payment Initiatives Combining Global Payments With Explicit Quality Incentives: A Systematic Review

Cattel, Daniëlle; Eijkenaar, Frank

doi:10.1177/1077558719856775

Cited by 58 publications

(51 citation statements)

References 98 publications

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“…Payment per activities encourages more procedure done, maintains fragmentation, and discourages prevention, which does not stimulate high-quality care to the patient [26]. According to the authors, high-value care should limit per capita cost, improve patient experience, and improve population health [27].…”

Section: Reimbursementmentioning

confidence: 99%

“…The components of the global base payment are, to a multidisciplinary provider group, for a cohesive set of care activities to a predefined population, fixed for a defined period of time, risk-adjusted, and with risk-mitigating measures. The components of the explicit quality incentives need to have a method of linking payment to quality, with quality measures and with quality incentive structure [26].…”

Section: Reimbursementmentioning

confidence: 99%

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Value-Based Healthcare

Ramos¹

2021

Bioethics in Medicine and Society

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Value-based healthcare is a new health-care model in which what is important is value to the patient. Value is a broad term, but in essence, it is the best outcome for the patient per dollar spent. To provide value to the patient, the medical practice should be centered around conditions and care cycles and the results must be measured. We now know that the model we have right now, the fee-for-service model, is not linked to quality of the patient. All around the world, many hospitals and clinics are making the transition to this value-based model. To provide the best for the patient, we must have the best medical evidence to follow. In the following chapter, we will cover a few aspects of value-based healthcare, its reimbursement model, the integrated practice units, and the information technology necessary to implement it.

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Section: Reimbursementmentioning

confidence: 99%

Section: Reimbursementmentioning

confidence: 99%

Value-Based Healthcare

Ramos¹

2021

Bioethics in Medicine and Society

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“…5 There are multiple frameworks and models for VBP, however they generally emphasize bundled-payment models for specific treatments or conditions or pay-for-performance models that reward measurable aspects of care. [4][5][6] In the United States, and worldwide, the interest in value-based health care is increasing rapidly. 4,5,7,8 VBP arrangements to date have focused mostly on physical health service delivery; however, interest is slowly growing for mental health and substance use disorder (SUD) treatment services.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 In response, some states, healthcare systems, and insurers are implementing value-based payment (VBP) arrangements. 3,4 Such arrangements incentivize cost-effective, high quality of care rather than quantity or volume, as in fee-for-service arrangements. Payments made to providers under VBP arrangements are often linked to defined quality metrics or a demonstrated value (eg, providing evidence-based practices; EBPs).…”

Section: Introductionmentioning

confidence: 99%

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How are Substance Use Disorder Treatment Programs Adjusting to Value-Based Payment? A Statewide Qualitative Study

O’Grady¹,

Lincourt²,

Gilmer³

et al. 2020

Subst�Abuse

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Healthcare systems are implementing value-based payment (VBP) arrangements in efforts to incentivize cost-effective, high quality of care. These arrangements represent a major shift for substance use disorder (SUD) treatment providers who may need to make changes to their clinical and business operations to meet new demands for quality under value-based contracts. This qualitative study was conducted in the context of New York State’s efforts to implement VBP among SUD treatment providers to understand their experiences, challenges, and needs. Five focus groups were conducted across the State with a total of 68 treatment professionals. Content analysis was conducted and five themes emerged. First, competing demands, limited workforce and technology infrastructure, and perceived lack of information were leading to overwhelmed administrators. Second, confusion and financial fear was being driven by the need for new clinical roles, business practices, and external partnerships. Third, providers were undertaking a number of measures to address workforce needs. Fourth, providers were building new business models and clinical practices. Fifth, providers desired more support and information. As VBP models are being adopted, healthcare systems should identify ways to mitigate challenges and support SUD treatment providers that may have limited resources to address complex workforce, client, and infrastructure needs.

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Medicare Beneficiaries’ Perspectives on the Quality of Hospital Care and Their Implications for Value-Based Payment

2023

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ImportanceMedicare’s Hospital Value-Based Purchasing (HVBP) program adjusts hospital payments according to performance on 4 equally weighted quality domains: clinical outcomes, safety, patient experience, and efficiency. The assumption that performance on each domain is equally important may not reflect the preferences of Medicare beneficiaries.ObjectiveTo estimate the relative importance (ie, weight) of the 4 quality domains in the HVBP program from the perspective of Medicare beneficiaries and the impact of using beneficiary value weights on incentive payments for hospitals enrolled in fiscal year 2019.Design, Setting, and ParticipantsAn online survey was conducted in March 2022. A nationally representative sample of Medicare beneficiaries was recruited through Ipsos KnowledgePanel. Value weights were estimated using a discrete choice experiment that asked respondents to choose between 2 hospitals and indicate which they preferred. Hospitals were described using 6 attributes, including (1) clinical outcomes, (2) patient experience, (3) safety, (4) Medicare spending per patient, (5) distance, and (6) out-of-pocket cost. Data analysis was performed from April to November 2022.Main Outcomes and MeasuresAn effects-coded mixed logit regression model was used to estimate the relative importance of quality domains. HVBP program performance was linked to Medicare payment data in the Medicare Inpatient Hospitals by Provider and Service data set and hospital characteristics from the American Hospital Association Annual Survey data set, and the estimated impact of using beneficiary value weights on hospital payments was estimated.ResultsA total of 1025 Medicare beneficiaries (518 women [51%]; 879 individuals [86%] aged ≥65 years; 717 White individuals [70%]) responded to the survey. A hospital’s performance on clinical outcomes was most highly valued by beneficiaries (49%), followed by safety (22%), patient experience (21%), and efficiency (8%). Nearly twice as many hospitals would see a payment reduction when using beneficiary value weights than would see an increase (1830 vs 922 hospitals); however, the average net decrease was smaller (mean [SD], −$46 978 [$71 211]; median [IQR], −$24 628 [−$53 507 to −$9562]) than the comparable increase (mean [SD], $93 243 [$190 654]; median [IQR], $35 358 [$9906 to $97 348]). Hospitals seeing a net reduction with beneficiary value weights were more likely to be smaller, lower volume, nonteaching, and non–safety-net hospitals located in more deprived areas that served less complex patients.Conclusions and RelevanceThis survey study of Medicare beneficiaries found that current HVBP program value weights do not reflect beneficiary preferences, suggesting that the use of beneficiary value weights may exacerbate disparities by rewarding larger, high-volume hospitals.

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Value-Based Provider Payment Initiatives Combining Global Payments With Explicit Quality Incentives: A Systematic Review

Cited by 58 publications

References 98 publications

Value-Based Healthcare

Value-Based Healthcare

How are Substance Use Disorder Treatment Programs Adjusting to Value-Based Payment? A Statewide Qualitative Study

Medicare Beneficiaries’ Perspectives on the Quality of Hospital Care and Their Implications for Value-Based Payment

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