Value Based Care
Overview
What is Value Based Care?
Value-based care is a care delivery model that prioritizes patient outcomes in the way that health providers are reimbursed. In this payment system, physicians and hospitals are rewarded for improvements to their patients health within a reporting period, including reductions to the effects and incidence of chronic disease and adherence to preventative care. In 2016, the Department of Health & Human Services (HHS) has set a goal of converting 50% of traditional fee-for-service Medicare payments to value-based payment models by the end of 2018. Since then, several commercial insurers have been moving in the same direction.
The value-based model places more ‘value’ on preventive care, to keep people healthy and prevent hospital admissions and ED visits. In a value-based care model, providers aim to achieve certain quality goals for a given population of patients at a pre-determined cost. Most value-based contracts include various quality metrics, to which physicians and hospitals are measured – and paid – in order to provide better quality care for patients with better outcomes.
What are HEDIS quality measures?
HEDIS stands for Healthcare Effectiveness Data and Information Set. HEDIS is a set of STANDARDIZED quality measures. This standardization helps the public compare the performance of organizations across the nation. The NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) coordinates and administers the program. HEDIS 2018 (2017) specifications include 95 measures across seven domains of care. HEDIS measures focus on prevention, screening, conditions across all body systems, access to care, satisfaction with care, as well as utilization of specific procedures and care settings. According to the NCQA, “HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.”
Some value-based contracts at UW Medicine:
Premera:
GOC
Regence:
TCC
Other populations:
Commercial: Cigna, Aetna, United
Medicare Advantage: multiple payors