In recent years there has been a drive to improve the value obtained from healthcare spending. When questioned, most health system analysts focus on improvements in quality of care, or on reduction of wasteful spending. What does value-based care look like to the doctors and nurses who deliver it? More importantly though, how does it look to the patients who receive it?
The U.S. Secretary of Health and Human Services announced just last year that a majority of healthcare payments in the U.S. Medicare and Medicaid programs will move to value-based payments by 2018. Many health systems have reorganized with a goal of improving the value of care.
In reality though, what does this change? As more healthcare delivery systems begin to refocus on improving outcomes and reducing costs, six principles have emerged of what value-based care looks like in practice.
Number One – Common sense prevails
An increasing issue seems to be that the structure of healthcare financing is getting in the way of medical staff and patients. Common sense needs to come into play. If a patient can be treated just as well at home by using remote monitoring devices, appropriate medication and home visits, this saves thousands of dollars that might otherwise have been spent on unnecessarily hospitalising the patient. It is a practical solution far better for the patient, saves money and is simply just ‘common sense’.
A great story to illustrate this was about a patient with kidney failure. His fear of hospitals meant he missed appointments, which meant his health slipped and he had to be admitted into hospital. Someone came up with the idea of buying him an iPod, so he could listen to music – something he found relaxing. This meant he then attended all appointments, got the treatment he needed and stayed out of hospital. A win – win situation, and a great example of a non-medical determinant of a health care outcome (see my previous blog).
Number Two – Prepayment as freedom not risk
Value based care is built on payment systems that reward desired long term outcomes, rather than episodes of care. The most progressive payment systems offer healthcare delivery organisations prepayment for defined sets of clinical services, ensuring that the patient gets the treatment required, rewarding more efficient healthcare and removing the perverse incentive of more visits generating more income under the fee for service model.
The fee for service model also doesn’t allow for the great idea of giving the kidney patient an iPod to calm his nerves, in order to successfully receive treatment. Under this model, which exists in Australia, payment is for episodes of treatment, rather than of healthcare achieved.
Number Three – Longer term view of patient outcomes
Organisations that are truly focused on value will not just look at patient health in terms of weeks or months, but instead will focus long term, over years. The meaning of true value for anyone with a chronic disease is prevention and delaying any progression. As an example, patients with early kidney disease are enrolled in chronic disease management programs which aim to control hypertension and diabetes, the exact two things that could make the disease progress. When eventually dialysis is needed, having a dedicated nurse for that patient helps to prevent unnecessary hospital admissions, which is better for the patient and obviously far more cost effective.
Number Four – New Roles to Support Delivery of Care
A value based Health Care Organisation will create new, more effective roles to help patients, rather than continuing with old, tired, less effective ones. The introduction of such roles like Community Health workers for example, are key in helping to manage those patients in need of chronic disease management, with conditions such as diabetes. It’s thinking out of the traditional box. Even the roles of Doctors has changed somewhat, following patients from the hospital setting, to skilled nursing facilities, to post-discharge follow-up in clinic.
Number Five – A Culture of Caring
Great value is one thing, but on its own is not enough. The main focus has to be on the patients themselves. Hearing first hand what really matters to them is of paramount importance to smooth treatment.
Getting patients input on written material is a great example from Boston’s Brigham and Women’s Hospital, whereby they enlisted patients to help rewrite medical materials to be more comprehensible and jargon-free. Better access, understanding and compliance from the patients reading them resulted.
Number Six – A “Whatever It Takes” Approach
True value-based care means thinking beyond the traditional boundaries of healthcare payment and delivery. It literally is ‘do whatever it takes’. If air conditioning units need to be bought to keep COPD patients out of hospital, or iPods purchased for the most nervous and afraid, this is what should be done. It isn’t the case of one size fits all, but rather adapting to individual needs.
This holistic thinking generates fitter, healthier patients, and greater staff satisfaction and efficiency. At the same time a great deal of money is saved by not having to hospitalise or use healthcare resources unnecessarily.
PHC can help your healthcare facility improve reputation and profit through improved workflows, reducing risk and cost and improving the healthcare experience for patients, doctors and staff. Make a time via http://bit.ly/PeriopDiscover, learn about our method at http://bit.ly/PeriopMethod or visit our website www.perioperative.com.au to learn how we can help you.