Value-Driven Healthcare Moving Into Your Practice

In last month’s issue, “From the College” gave a brief overview of the theory of value-driven healthcare; in this month’s edition, we’ll move from the theory of value-driven healthcare to its implementation in today’s healthcare system.

Value-driven healthcare involves more than the pay-for-performance or reporting of quality measures with which it is often associated. The reporting of quality measures is only one of many tools in the value-based purchasing tool box that aims to reduce fragmentation and duplication, effectively manage chronic disease, accelerate the adoption of effective and interoperable health information technology (IT), and empower consumers to make good choices and actively engage in their healthcare.

The Centers for Medicare & Medicaid Services (CMS)—as well as key players in the private payer industry—is now moving towards value-driven healthcare through a series of demonstration projects. CMS is also implementing large-scale programs that are expected to bring Medicare beneficiaries one step closer to engaging in and receiving high-quality and efficient care, delivered at the proper time.

CMS has identified four key elements of value-driven healthcare and is focusing on these cornerstones when designing programs that seek to place measures at every level of the Medicare care delivery system, from the interaction with the individual patient and provider to the institution facilitating care. The four cornerstones are:

  1. Health IT: The development of IT standards that allow rapid communication and transfer of data in a secure environment that protects patient privacy.
  2. Quality Standards: The establishment of quality measures that allow consumers and providers to make informed healthcare decisions.
  3. Price Standards: The establishment of cost-of-service measures and price transparency that also contribute to informed decision making.
  4. Quality Incentives: The development and implementation of pay-for-performance programs and other measures that reward not only providers of cost-effective quality care, but also those making buying decisions based on quality as well as cost effectiveness.

CMS Value-Driven Healthcare Demonstration Projects

As your practice prepares to engage in current and future value-based programs, it is important to know what pilot programs and demonstration projects are currently underway and to review these programs for important lessons learned that are applicable to your practice.

CMS is engaged in several demonstration projects addressing each of these key points and spanning the full spectrum of care settings, from hospitals to physician practices. These demonstration projects are developed to evaluate each program in relation to the goals of attaining quality-of-care improvements, cost-efficiencies, and transparency of information.

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