A Master Class in Value-Based Care

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Patients are increasingly kept out of the hospital in an effort to lower costs and increase efficiency.

This is because the nation’s hospitals are moving from a fee-for-service payment model into one that rewards quality and safety. Beginning next year, Medicare will require that at least 30 percent – and 50 percent by 2018 – of all payments shift from fee-for-service to alternative models based on quality of care, not services provided.

At a breakout session titled “A Master Class in Value-Based Care” Tuesday at the U.S. News Hospital of Tomorrow conference in the District of Columbia, expert discussed how hospitals and health care systems are paving the way amid these changes. 

Panel participants included Dr. Jim Frankfort, chief medical officer and vice president of clinical informatics for IMS Health; Dr. Harlan Levine, chief executive at the City of Hope Medical Foundation; and Dr. Michael Schatzlein, senior vice president and group ministry operating executive for Ascension Health. 
Mary Bacaj, vice president of strategy and chief of staff for value-based care at Conifer Health Solutions, moderated the conversation. 

  • Frankfort said hospitals will need to work collaboratively to collect more data that address subtle issues in cost and quality. Most gains, he said, have come because of reduced emergency room visits and reduced admissions. 
  • Levine said much of the burden for finding a health plan has been placed on patients, and consumers are placed in the middle of health care to make decisions about cost. “Patients don’t have the time to think about what network they should be in,” he said. “When you think about people who are critically ill, you have to make sure the pendulum doesn’t swing too far, and you still have to create access for people who are critically ill.” 
  • Schatzlein points out that the new payment toward value-based models go against what patients want, because they limit access to some providers. 
  • Some patients, Levine said, could benefit more from a meeting with nurse practitioners, and others could save trips to the doctor’s office by using telemedicine. He cautions, however, that some of the initiative for patients is best served for those looking at routine care. Consumer shopping for care can drive down the cost of care, he said, but in more urgent settings or for complex conditions, it begins to fragment care to put the burden on the patient.
  • When it comes to expanding Medicaid, the government’s program for low-income Americans, Schatzlein said expansion is only part of the solution. Many patients, he points out, will be getting health care coverage for the first time. Therefore they’ll need guidance when it comes to using the health care system and finding a medical home. Health care providers, he said, will need to take a proactive approach, such as providing transportation. 

Levine says ultimately providers understand that the country cannot continue to spend as much as it does on health care. “We need to not have too much cost to put back on the patient,” he said. “We need to not have too much economic cost on the medical groups.” 

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