Shifting Values

employer_health_insurance_changes.jpg

Contributed by staff writer Amanda Fraraccio

Healthcare is a vital component and often debated part of our society. We are all impacted by this vast industry. There is a monumental shift underway in the delivery of healthcare and we would like to take a little time to explore what is occurring.

Healthcare in the United States is expensive, can be inefficient, and the quality is varied. The goal of value-based care is to fix those issues (Cosgrove, 2013). In a fee-for-service system providers are paid based on the volume of healthcare services they deliver (NEJM Catalyst, 2017).  In this model every test ordered, and procedure completed increase the bottom line. In a value-based model providers, including hospitals and physicians, are paid based on patient health outcomes instead of number of services delivered. This can mean improving patient’s health brings greater financial reward than continuing to treat illnesses (NEJM Catalyst, 2017)

Data is helpful in making this systemic change. Collecting data can identify variations in clinical practice leading to unwanted outcomes. For example, Cleveland Clinic was able to utilize data of heart-surgery patients to determine that “those who received blood transfusions during surgery had higher complication rates and lower long-term survival rates.” (Cosgrove, 2013) This finding changed their procedure and led to adopting strict guidelines to limit transfusions. They achieved improved quality of care and better outcomes. Data collection at Cleveland Clinic has also led to changes in procedures reducing central-line infections by more than 40%, and urinary-tract infections dropped 50%. (Cosgrove, 2013). Data collection in the field of obstetrics have shown that key developmental processes occur between 37- and 39-weeks gestation.  Babies born at or after 39 weeks have the best chance at healthy outcomes compared to those born before 39 weeks. This information has led to a decrease in induction of labor as well as elective delivery of babies before 39 weeks (The American College of Obstetricians and Gynocologists, n.d.).

Benefits of value base healthcare to patients include:

·         Spending less money to achieve better health

·         Focusing on recovering from illness and injuries more quickly

·         Avoiding chronic disease in the first place

Benefits for providers include:

 ·         Spending less time managing chronic disease

·         Increasing quality of care by focusing on value of services instead of volume

·         Less financial risk

Benefits to society include:

·         Spending less money assisting people managing chronic disease

·         Spending less money on hospitalizations and medical emergencies

·         Reducing overall costs spent on healthcare, lost wages, and productivity (NEJM Catalyst, 2017)

 There are many benefits to moving toward value-based care however, systemic change can be difficult, and roadblocks exist. Next month we will identify obstacles and ways providers are working to implement changes.

 

References

Cosgrove, T. (2013, September 24). value based healthcare is inevitable and thats good. Retrieved from Harvard Business Review: https://hbr.org/2013/09/value-based-health-care-is-inevitable-and-thats-good

NEJM Catalyst. (2017, January 1). What is value based healthcare. Retrieved from NEJM Catalyst: https://catalyst.nejm.org/what-is-value-based-healthcare/

The American College of Obstetricians and Gynocologists. (n.d.). Deliveries Before 39 Weeks. Retrieved from acog.org: https://www.acog.org/About-ACOG/ACOG-Departments/Deliveries-Before-39-Weeks?IsMobileSet=false