Value Based Care: Challenges of a Changing Care Paradigm

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MACRO/POLICY CLUSTER – PROJECT 09-05161.CHOT

Value Based Care: Challenges of a Changing Care Paradigm

Description

Pay-for-value (P4V) or value-based care models are the latest attempts from commercial and government healthcare insurers to shift the care paradigm from episodic towards comprehensive care. Unlike fee-for-service models, P4V models reward quality care, penalize readmissions, and encourage comprehensive healthcare coverage that aligns quality measures with reimbursement. Under P4V, patients would spend less time in the hospital and receive more routine care from primary care practices. Although P4V programs, such as Pay-for-Performance (P4P), Patient Centered Medical Homes (PCMHs), and Accountable Care Organizations (ACO), have shown success, full implementation will require a fundamental shift in how healthcare is delivered and how healthcare workers are organized, trained, and compensated. Applying stakeholder analysis, CHOT will evaluate the challenges of implementing P4V from the perspective of hospitals, physicians, insurers, medical colleges, and patients. Findings will reflect the concerns of stakeholders, facilitators and barriers to implementation, and help inform future health policy decisions.

How is this different from related research?

P4V is not widely implemented nor tested. There is little research on the pros and cons of implementing it, and there are numerous new variants of P4V models each year. The comprehensive care for joint replacement (CJR) P4V bundle is the latest from the Centers for Medicare and Medicaid Services (CMS); however, its success hinges on a hospitals ability to reduce costs and prevent readmission. This multi-university research team will document the concerns of stakeholders from across the healthcare
industry including most CHOT industry members. The researchers will also learn from the Mass BCBS “alternate quality contract” experience. All four current CHOT university sites are contributing to this project.

Value Proposition

  • Develop a consolidated list of stakeholder concerns
  • Predict and understand future healthcare direction and share challenges and successes of pay-for-value model implementation
  • Compose a white paper with health policy recommendations
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