Question 1
What is the value-based healthcare and how it differs from similar models of healthcare,
such as pay-for service model and etc.
Value-based healthcare refers to a healthcare delivery model through which providers,
comprising physicians and hospitals, are paid according to patient health outcomes (NEJM
Catalyst, 2017). Under the agreements stated in value-based care, providers are rewarded for
assisting patients in enhancing their health, lowering the impacts and incidence of chronic
illness, and residing healthier lives in an evidence-founded manner. Value-based healthcare
programs are significant to an excellent quality approach in reforming healthcare delivery and
finance (NEJM Catalyst, 2017). It backs up the triple-target of offering better care for healthier
health for populations at a reduced cost. When transitioning from any other model to value-based
care, multiple reimbursement strategies are available to the healthcare providers.
Value-based care varies from a fee-for-service, also known as capitated strategy, through
which providers are compensated according to the level of healthcare services they offer. The
worth in value-founded healthcare emanates from measuring health results in contradiction to the
expense of delivering the result. The traditional fee-for-service approach promotes healthcare
physicians to visit many beds and do numerous procedures (NEJM Catalyst, 2017). That
prospers in increasing healthcare costs though it doesn't enhance patient results. On the other
hand, value-based care places the outcome's quality first, and tethering reimbursement to this
metric incentivizes healthcare providers to prioritize patients, together with a group of healthcare
administrators, who have to respond how they can conform to the new system while conforming
to the budgetary limitations.
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Fee-for-service models may not be entirely on their way out of the entire healthcare
industry. However, the value-based care approaches are pushing their strategy in. With the
government back up, backing VBC as an outcome of the ACA and Medicare (via the Centers for
Medicare and Medicaid Services), patients tend to anticipate seeing the VBC approaches become
more common as time moves on (NEJM Catalyst, 2017). Value-based care denotes the query
that all meaningful healthcare reforms perform how one manages to finance it. With numerous
debates surrounding the healthcare reform, the replies to that question are multiple though
necessarily intricate.
Other models that differ from the value-based model include bundled payments and
population-based payments (PBP). The two differ from the value-based model in that, under
bundled payments, healthcare providers coordinate care much earlier and presume that some
dangers cover costs that move past the price of a sole care episode. However, they share some
savings upon keeping the costs down while sustaining quality standards (NEJM Catalyst, 2017).
Under the PBO, healthcare providers are offered to meet population-extent targets. They are
responsible for patient-centric care for a particular population over a specific population over a
specific period over the entire range of care.
Question 2
Summary of Value-Based Healthcare Benefits
Most healthcare systems are switching to a value-based healthcare model since providers
and patients benefit in various ways.
Patients Spend Less for Better Outcomes
Since value is at the healthcare system's heart, patients will pay lower to obtain the
necessary care. Care providers concentrate on preventive care that is less expensive than treating
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a chronic disorder such as obesity, hypertension, or diabetes in value-based healthcare systems
(NEJM Catalyst, 2017). Still, providers and physicians concentrate on treatment approaches that
assist patients in recovering from injuries and illnesses more professionally. A patient in a value-
based healthcare classical will have more minor medical procedures, medical tests, and doctor’s
visits. Furthermore, they spend less on medication as their health advances.
Patient Satisfaction Rates Increases in the Value-Based
In value-based healthcare, patients are the healthcare process' focus. They obtain
cooperation care from all of their workers. Dissimilar to the fee- for- facility model, doctors,
concentrate just on treatments and tests that are excellent for patients instead of doing as much as
conceivable to gather a lot of money. Not just does that save cash, but the period used during the
follow-up or exam visit is most engaging and productive. Patients feel like they are amongst the
team instead of an item on a list to be verified.
General Reduction in Medical Errors
Value-based care assists in reducing medical errors, which are the primary concern
amongst the insurance sponsors, who have recognized that a lot of their expenditure goes to
ineffective or harmful treatments. Therefore, many corporations are turning to value-based care
to decrease medical errors. The healthcare provider's company data is gathered and analyzed
(NEJM Catalyst, 2017). Data analysis assists companies know health risks detailed to a system
or provider. The association can then obtain steps to offer defensive care for those risks and
make treatment most effective. Implementing alterations to advance preventive maintenance is a
period saving for various providers. Still, the advantages on the other end far balance that
expense when they spend lower time managing and treating chronic disorders.
General Society becomes Healthier.
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With value-based care, society at a lower cost overall becomes healthier. Medical
emergencies and hospitalization could reduce, and more insufficient money could spend on
managing chronic disorders. As an outcome, general healthcare expenditure expenses are
reduced. Concentrating on preventing diseases and offering efficient treatments translates to
residents with fewer chronic conditions. The healthier the inhabitants are, and the less money all
parties use on healthcare, the more beneficial.
Question 3
How can the New Model of Care contribute into having a value-based healthcare?
The value-based healthcare proliferation has changed how hospitals and physicians
provide care. New healthcare delivery models stress encourages a team-oriented approach to
patient care and sharing data regarding parents to ensure the care is coordinated, and outcomes
are measured easily. The new model of care contributes to having value-based healthcare
through two primary value-based models: Medical Homes and Accountable Care Organizations
(ACOs). Regarding the medical homes, the models in value-based healthcare ensure that medical
care does not exist in silos. Instead, it integrates specialty, primary and acute care in a delivery
model known as a patient-centered medical home (PCMH). The term Medical Homes does not
refer to a physical location, but it refers to a coordinated approach to patient care with the
primary physician directing the entire clinical care team of the parent (NEJM Catalyst, 2017).
The model relies on sharing electronic medical records between every provider on the
coordinated care team. The electronic medical records put crucial patient information at the
fingertips of each provider, ensuring that individual providers can see procedures and results of
tests performed by other physicians on the team. Sharing of data reduces redundant care and the
associated costs.
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Accountable Care Organizations (ACOs) are designed to provide high-quality medical
care to Medicare patients. Hospitals, doctors, and other care providers work a networked team to
achieve better-coordinated care at a lower cost within this model (NEJM Catalyst, 2017). The
team members share the cost-share the reward and the cost with incentives to increase access to
healthcare, health outcomes, and quality of the care with reduced costs. The strategy differs from
fee for service healthcare whereby the individual providers are incentivized to order multiple
procedures and tests and attend to several patients to get more paid irrespective of the patient
outcomes. Like PCMHs, ACOs are patient-centered organizations where care providers and
patients part when making decisions. The organizations also ensure data sharing and strong
coordination between the team members to ensure they achieve goals for all patients. They also
share claims and clinical data with payers to demonstrate advancements in outcomes.
Question 4
MISSING INFORMATION
Question 5
Discuss how DRG is linked to ACOs?
Diagnosis-Related Groups were established as Medicare's hospital reimbursement
systems. The systems are patient classification schemes that offer means to relate the kind of
patients that a hospital treats to the total costs incurred by the organization. The initial motivation
to develop the DRG was to create a practical framework that monitors the quality of care and
utilization of services within a hospital (Centers for Medicare & Medicaid Services, 2019). The
DRGs and ACOs link in several ways: both the DRGs and ACOs can provide and manage with
patients, the care continuum across various institutional settings that include inpatient and
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ambulatory hospital care, and the cost of acute care. Also, the two schemes have the capability to
prospectively plan resources and budget needs and have a sufficient size to support valid,
reliable, and comprehensive performance measurements.
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References
Centers for Medicare & Medicaid Services. (2019). Design and development of the Diagnosis
Related Group (DRG).
NEJM Catalyst. (2017). What Is Value-Based Healthcare? Retrieved from
file:///C:/Users/user/Downloads/What%20Is%20Value-Based%20Healthcare_(1).pdf