Value Based Care, ACS Equation (Frank) | | Quality over cost, elevate quality to value of cost Care in a value based direction, with cost in mind Issue: fatigue around value based care concept…evolution in how it is perceived To deliver at Enterprise level, some hurdles to overcome Frank inputs: Thrive Program with Harvard, episodes of care Expressing through Value Expression How to define Value Based Care and its subcomponents? Viewing value as a judgement; we each apply different perception components; it is personnel; difficult then to express from a data perspective Quality/Price; Costs required for this episode of care How to represent patient’s judgement; experiences and sensitivities; are we meeting their expectations and goals? Through: patient reported outcomes…get rid of pain, treated respectfully…respected end of life wishes…etc; series of plots like a radar plot/chart Outcome: add all the pieces of and then map them out Sensitivities: race, gender, background, etc….and how they overlay each other; expectations of health care system are very different; not sure what to expect vs. just want a good outcome vs other Clinical success is not always equal to value PROs as elements of the formula; PRO to be tailored to population being worked with; some are in place by researchers
Lee notes Value based care equated to bundled payment Quality of patient care for entire episode for least amt of $ being spent Drives better patient outcomes and drive down cost for patient care; outcome is that more of these are being rolled out more broadly National standard for bundles (Frank) in process, key for scaling; care is episodic once you get past transactions; did the outcome achieve the results? Note on price: match to disease, not being done (for most part) today; must consider overall amortized price eg 1 yr of outcomes vs 10 yr of outcomes (cost in the end for bad care) Corporation bundle model - required to be pitched to ind insurance companies, drives lack of standard for payment Where bundles working well? Poorly? Danville - profitable and high quality of care, seen as the gold standard Simple, procedural bundles 600 and conditioned bundles 200; conditional level is really the opportunity for savings moving forward CHF bundle this year as well not necessarily same as “carve-outs”
Final thoughts Frank: care model for each episode, resource model, come together with data models, all to inform, payment model, compensation model, competition, (value based); roles to play for several different aspects for implementation to be successful (ACTION: more discussion) How CAC to help? focus on quantification…make it a reality
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