Patients Charting the Course Citizen Engagement and the Learning Health System: Workshop Summary (2011) / Chapter Skim
Currently Skimming:
9 Incentives Aligned with Value and Learning
9 Incentives Aligned with Value and Learning
Pages 213-234
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 213... ...
Integral to realigning the health system are comprehensive performance measures that are based on solid evidence and observability as well as incentives that reward positive health outcomes. The second paper, presented by Richard Gilfillan, formerly of Geisinger Health System, makes a business case for practicing evidence-based, integrated care rather than the high-volume, fragmented care typical in much of the United States.
|
From page 214... ...
Active in 17 regions around the country, leadership teams of multiple stakeholders are involved in crafting performance measures, building quality improvement infrastructure, and assessing ways to better engage the public in the concept of a learning health system. The authors state that through the AF4Q initiative, the Foundation hopes to learn how to improve messaging, encourage community participation, and stimulate a learning culture.
|
From page 215... ...
Payment reform, including value-based purchasing, is largely a provider-centric way of promoting value. This is in contrast with valuebased benefit design, which is patient-centered.
|
From page 216... ...
This fiscal imbalance must be resolved, the mechanisms used will define the healthcare system of the future, ideally promoting value while constraining spending. Alternate Payment Systems Incentives and payment for promoting value must be designed to control aggregate spending.
|
From page 217... ...
The global budget is updated over 5 years, in general by the consumer price index, so providers agree to a global payment trajectory for 5 years. This is not a 1-year capitation.
|
From page 218... ...
Evidence takes time to develop and to be accepted. Some outcome measures, however, such as patient satisfaction, complications, and readmission rates, hold potential for capturing innovation.
|
From page 219... ...
The recent healthcare reform legislation includes a number of alternative reimbursement approaches for Medicare and Medicaid. Private payers could work closely with the Centers for Medicare & Medicaid Services (CMS)
|
From page 220... ...
The right business models to produce high-value care are unknown, although proposals abound. Congress has included a variety of new payment initiatives in the healthcare reform legislation so that different models can be evaluated.
|
From page 221... ...
Producer-Centered Volume Innovation and Learning The current healthcare business model directs innovation in three ways. Businesses proactively select innovation and learning opportunities based on the expected business development opportunity.
|
From page 222... ...
The United States does not have low-value health care because it lacks knowledge about delivering high-value care, but because the healthcare business model rewards and thereby drives low-value care. Innovation and learning need to be focused on patient-centered value business models that reward them.
|
From page 223... ...
Patient satisfaction metrics monitor the patient experience of care. Improvement in these measures of success leads to better financial results for the Clinical Enterprise.
|
From page 224... ...
ProvenHealth Navigator: • Population -- all Medicare beneficiaries seen in primary care offices • Care innovation -- value-driven medical home model based on part nership between primary care providers and GHP • Business model innovation -- fee for service supplemented with sti pends and a quality-driven shared savings model • Measures of success -- triple aim outcome metrics for health status, patient experience of care, cost of care • Results -- improvements in Healthcare Effectiveness Data and Infor mation Set, patient satisfaction, and cost metrics (Table 9-3) Patient-Centered Value Learning This patient-centered value business model focuses learning on systems to improve outcomes.
|
From page 225... ...
Diabetes bundle 30 Coronary disease bundle 20 Preventive care bundle 75 Innovation: EHR-driven registries and reminders Evidence Development: Physician-specific monthly Healthcare Effectiveness Data and Information Set (HEDIS) metrics Incentive: Straight pay for performance TABLE 9-3 Value Learning: ProvenHealth Navigator Results Improvement Admissions Decreased 16% Readmissions Decreased 30% Quality metrics Improved as noted in Table 9-2 Innovation: Medical home with population management built into the primary care office Evidence Development: Process and outcome metrics for surgical care Incentive: Fee for service, pay for performance, stipends and shared savings paid based on quality outcomes better.
|
From page 226... ...
Other parts of the system operate with a more traditional volume-based model, albeit within the culture of a not-for-profit multispecialty group practice. The results demonstrate what is possible within an organization operating two business models.
|
From page 227... ...
The reimbursement innovations for providers and MA plans in the recent healthcare reform legislation will drive movement in that direction. The greatest impact would result if public and private payers developed a common approach that gave providers an unambiguous context in which to deliver higher-value care.
|
From page 228... ...
Freda, M.P.H. The Robert Wood Johnson Foundation The American healthcare system faces critical challenges, including poor quality, skyrocketing costs, and troubling racial and ethnic disparities.
|
From page 229... ...
In each region, a multistakeholder team of healthcare leaders, physicians, nurses, consumers, health plans, business, and others carry out three key activities: they issue public performance reports on hospitals and physicians, develop a sustainable capacity or infrastructure to help physicians improve, and work to engage consumers in using healthcare information. For this strategy to succeed, different stakeholder groups need to reach fundamental agreement on difficult tasks, such as defining and measuring good care, engaging professionals in efforts to improve care, and getting patients and consumers more involved in different aspects of their care.
|
From page 230... ...
Subsequent message research with a physician audience emphasized AF4Q's focus on measuring and publicly reporting on the quality of care. This research revealed that physicians are understandably focused on how performance data are collected, adjusted, and analyzed and how the data will be used; they expressed the greatest confidence in initiatives led by their peers.
|
From page 231... ...
Major messages used with the employer audience include both the direct and hidden, indirect costs of poor health care; the added premium costs of wasteful, poor-value care; and examples of companies that have made a difference. Engaging Health System Leaders Health system leaders, such as hospital board members, do not always make quality a strategic priority (Jha and Epstein, 2010)
|
From page 232... ...
A learning health system should focus on and promote the issues that matter to patients and families. Creating a Learning Culture: Some Conclusions Although not backed by rigorous research results at this point, some insights about how to create a learning culture within the healthcare system have emerged from RWJF's experience in promoting social change and AF4Q's experience to date: • Test change in local markets -- Although healthcare quality is obvi ously driven by federal and state policy, as well as private market developments at every level, health care is delivered locally, and it is important to gain experience in different market environments around the country.
|
From page 233... ...
Washington, DC: The Center for Health Care Quality, George Washington University Department of Health Policy. RWJF (Robert Wood Johnson Foundation)
|
From page 234... ...
Health Affairs 29:5.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.