Financial Factors Within A Value Based Care System

The U.S. spends more resources on healthcare than any other nation. Yet, the The Commonwealth Fund (2014, para. 1) claim the U.S. health system consistently ranks last or near last relative to other industrialized nations regarding health outcomes. Consequently, insurance companies are adopting a value-based reimbursement system aimed at containing costs and improving clinical outcomes (U.S. Department of Health and Human Services, n.d., para. 35).

The change to value based purchasing has bought many challenges to the healthcare industry. With the change to value-based purchasing for payments, it has changed how healthcare organization receive payment and delivery care. The advantage of have value based purchasing is that it improves the quality of care while reducing cost in an effort of aligning patient’s with the right provider and treatment plan (Minemyer, Jun 29, 2016). However, there are many disadvantages, such as it increases the patient volume as counteracting the reduction of procedure volume (Brown, B. & Crapo, 2016). Also it makes providers more responsible for care that is beyond the expected treatment of care needed (Minemyer, Jun 29, 2016). With quality measures tied

The article discusses how the transition from fee-for-service models to value based care will affect the industry both private and CMS. It outlines that there is still uncertainty about how there are still huge concerns in relation to these new reimbursement and care delivery models. This article goes into detail about how the transition to value based care from fee-for –service will affect physicians. It examines early physician training and how physicians must now transition from independent work toward care coordination. It also looks at the need for more primary care physicians and the possible retraining of many physicians to provide more of a disease states focused care. Finally, the article points out that specialist and primary care

As expense for-volume offers approach to charge for-worth, doctor 's facilities and social insurance frameworks are finding that their time-tried blocks and-mortar development methodologies will no more serve their long haul objectives. Today 's quality driven clinical and plans of action require a movement in center — from experience based solution to populace wellbeing administration. Systems to advance development — fundamental for quality based achievement — will depend on patient maintenance and new instruments for picking up piece of the pie.

It aligns best with our goals and mission for having our customers at the center of our business. Hospital Value-Based programs reward hospitals for the quality of care that is giving to people with Medicare. [8] It focuses on three requirements that IBC should aim high to meet. Better care for the individual, better health for population, and lower cost are the goals of value-based programs and IBC. With value-based programs, hospital records would be open to the public and increase transparency, and it emphasizes the need for organized purchasers.

The textbook, “Redefining Health Care”, written by Michael E. Porter and Elizabeth Olmstead Teisberg introduces readers to the complex world of healthcare in the United States. Porter and Teisberg looked at major problems in the healthcare system and found that problems in healthcare were directly linked to the excessive costs of healthcare that had absolutely nothing to do with high quality care. “Redefining Health Care”, tackles the issues of how the United States can repair the healthcare system by utilizing economist strategies such as value-based competition to repair the healthcare system.

With our healthcare system evolving now with the Affordable care Act focusing on less hospitalization and more outpatient settings, there will be more efforts for value-based healthcare, when targeting a specific population health group, to focus in providing better quality and patient-center care with more wellness programs and preventive regiments

Volume-based health care means that healthcare providers received a payment for providing a particular service, regardless of the outcomes or need, For50 years healthcare has been reimbursing based on volume-based service. Whereas Value-based healthcare is when explicitly incorporates outcomes, is broadly defined as outcomes divided by costs. One of the major problems of health care today is the quality and cost of medical care. One major cause of the problems is the current payment systems that encourage volume-driven, rather than value-driven care. Physicians, hospitals, and other providers gain increased revenues and profits by providing more services to more people.

Value Based Purchasing refers to a strategy used by employers and the Federal government to provide excellence in health care. It entails improving healthcare quality in order to improve population health. The program is used by Medicare and what is included is measuring and reporting comparative performance, paying providers based on performance, and designing health benefit strategies and incentives to encourage individuals to provide higher quality care. Leaders should be concerned because although people are working hard to ensure everyone has access to good health care, the problem is keeping it affordable. Also, value-based purchasing is in its early stages, therefore there is lack of data. It is important for leaders to have evidence-based care in order to provide the best preventative care possible.

Medicare has introduced value based system. It will give reward to those hospitals which are offering quality services and punish which are not.

Along with physicians receiving training on different methods to treat patients, a solution that would greatly reduce the U.S.’s healthcare expenditure is switching from a FFS payment model, to a P4P model . P4P has been proven to reduce costs, improve the quality of healthcare, and improve patients’ health whenever this model is implemented within an institution. One example of many is the success of the Cleveland Clinic, a non-profit academic hospital located in Cleveland, Ohio. This clinic utilizes a Value-Based Care Team composed of nurses, physicians, and other experts to care for its patients. This clinic reached the Top 20 of the University HealthSystem Consortium’s (UHC) quality index, earning UHC’s Rising Star award by improving in all six measurements: patient centeredness, mortality, equity, efficiency,

The global healthcare industry is experiencing a fundamental shift as it moves from volume-based to value-based business. With increasing demands from consumers for improved healthcare quality and increased value, healthcare providers are under pressure to produce improved outcomes. Primary care physician and nursing shortages, are requiring overworked professionals to do more and be more efficient. Further, the cost dynamics of healthcare are changing, driven by people living longer, the incidence of chronic illnesses and infectious diseases, and distrustful medicine practices. New approaches to healthcare delivery is increasing in complexity and competition. This complexity challenging the healthcare industry will require smarter, more informed decisions to enable the improved outcomes and better value required by the market dynamics, increasing government regulations, and today’s more informed and demanding consumers (Cortada, J. & Gordon, D.,

Under payment, an ideal healthcare system will have the challenge of delivering higher quality for lower costs. The system’s payment reform will involve a transition from fee-for-service to global from systems that are value-based important for the achievement of the overall healthcare goals. An ideal healthcare payment system will give a great deal of support to value-driven system of healthcare delivery (Kent, 2013). The fee-for-service payment system will be of great importance to the healthcare system as it will help control the costs of health care.

Employers play a crucial role in quality and risk management. They developed many strategies for purchasing of health insurance. The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers.

The positive outcomes that have resulted due to value base programs have caused the model to gain traction and ignite one of the largest changes in history in the health care marketplace. By linking reimbursements to service quality, insurers such as the Centers for Medicare and Medicaid Services have facilitated a massive leap forward in the performance of United States health care providers. This achievement is a considerable accomplishment in the face of an institution that has received reimbursement from insurers via a fee-for-service model during the last 75 years. Soon, valued based payment models will represent the norm as more insurers support initiatives such as shared savings program, integrated clinical care, and accountable care payment models.