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Value-based Payment Models: HHS Efforts to Transform Current Healthcare


Value-based payment models: HHS efforts to transform current healthcare systems



Executive summary

In this research article written by the U.S. Department of Health and Human Services News Division, measurable goals and timelines are clearly defined to enhance the Medicare program, as well as the overall healthcare system. Essentially, the main goal of this article is to implement the idea of paying providers based on the quality of care, rather the quantity of care given to patients. The HHS set a goal of planning enhancements in Medicare to improve the quality of care, by suggesting provider repayment be reimbursed by the quality of care. Commonly, providers are reimbursed by the volume of patients seen, instead of the quality of care received by patients.

In recent years, healthcare has begun to transition to place more responsibility on providers and focus more on the quality of care delivered. The article continues to detail the efforts of this program and credit the efforts of the Affordable Care Act. The ACA helped to establish and continues to develop alternative payment plans for healthcare.


Key issues

Value-based care repayment methods have begun to become widespread across the United States. Prior to the introduction of the value-based care repayment method, providers were commonly being reimbursed for unnecessary services, as well as not wisely creating a financial incentive to coordinate care for patients (U.S. Department of Health & Human Services News Division, 2015). The sole purpose of alternative payment models is to improve health outcomes and improve the quality of care delivered.

Although not clearly outlined in this article, there are issues with implementing this payment model. For example, both payers and providers have faced mixed results seen during the beginning years of the implementation of alternative payment models. According to the National Academy of Medicine, providers have found that performance measures do not accurately reflect quality improvements efforts (Gruessner, 2017). In addition, clinicians have reported administrative burdens in relation to complying with the demands of alternative payment plans. Although not mentioned in this article, statements from the Healthpayer Intelligence, (Gruessener, 2017), suggest that key stakeholders have concerns regarding the high-cost treatment plans and how this would relate to alternative payment models.


Situational analysis

Due to the mixed views of the benefits of value-based payment alternatives, it is important to understand the strengths, weaknesses, threats and opportunities of this payment model. As stated in the article, a fundamental strength of this model includes changing the way healthcare services are administrated, by holding physicians more responsible. A weakness of this model is the lack of support from providers that have opposing opinions about the benefits of this program; this lack of support can become a proven threat to the success of the goals outlined by HHS.


Strategy formulation

To combat the issues with the goals outlined by the HHS and potential opposition from providers, it is important to construct an effective strategy. Proposing a team-based model for the delivery of care can improve the success of value-based payment models and reduce the opposition from healthcare providers (EHRIntelligence, 2017). Providers and healthcare facilities would benefit from the development effective quality management. Internal quality management is important in relation to value-based payment models, because quality measurement will allow healthcare professionals collect data from services provided, while making improvements to adhere to the principles and guidelines of value-based payment models.


Recommendation

In relation to the strengths of the implementation of a central value-based pay system, it is recommended that healthcare facilities utilize the numerous numbers of payment models that have been created due to the enactment of the Affordable Care Act. Also, in relation to the strengths of value-based payment model goals of the HHS, it is critical to encourage the commitment to long-term quality improvement. Authors McMaus, White and Schmidt (2018), suggest that it is important to incorporate utilization and cost quality measures; in doing so, providers will be able to represent decreases in healthcare spending. Lastly, since the article does not clearly define how different facilities would implement this model, it would be beneficial to provide a detailed approach or guidelines for all types of facilities to successfully implement this payment model to help transform healthcare.


Implementation strategies

To successfully implement value-based payment models, it is important for the HHS to gain support for the Health Care Payment Learning and Action Network; through this network, providers, insurers, consumers and all other related healthcare personnel will be have access to information outlined by the HHS (U.S. Department of Health & Human Services News Division, 2015). A prospective action plan would also encourage providers to prepare their organization for the shift away from fee-for-service payment models. It would be beneficial for providers to construct a team-based initiative to help align providers and healthcare professionals with the principles related to value-based payment models (Revcycle Intelligence, 2018). It would beneficial for providers to upgrade their technology systems to support the requirements of alternative payment models.


Benchmarks for success and contingency plans

To effectively measure the success of the implementation of value-based models and goals set by the HHS, it is important that all organizations develop healthcare management strategies to achieve the best results and represent the decreased number of healthcare spending dollars. For example, to measure success, providers can develop internal assessments to ensure that they are complying with guidelines of the value-based payment model. These benchmarks can also evaluate performance and quality measures and provide access to data. It is also suggested by authors Counte, Howard, Chang and Aaronson (2019) providers and healthcare facilities accurately measure and report a group or metrics across four domains, which includes “safety, clinical care, person and community engagement.” As a contingency plan, it is important for HHS to develop counter- goals that can be set in place if the current goals of the organization are not met.


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