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Value-Driven Healthcare and Reimbursement Programs
Value-driven health care strives to link reimbursement and quality of services provided to patients. The policymakers leverage public reporting as a way to improve care quality, making information open and accessible for all. For example, according to the recent research conducted by Kavanagh, Cimiotti, Abusalem, and Coty (2012), reporting strategies include standardization and coalition with both public and private organizations. Among the measures to report, there are cost, quality, surveys, and other information that may be interesting and useful to employers and employees. Performance measurement is to be collected from health plans and care providers and translated into standard requirements in terms of the quality-based purchases.
As for value-based payments, it is essential to mention pay-for-performance programs (P4P), which focus on the most critical problems to determine the amount of reimbursement. At this point, two different approaches may be noted. The first one targets individual caregivers, thus creating strong associations between performance and incentives. The second approach aims to consider hospital systems and groups and motivates them to behavioral change by bonuses and empowerment (Kavanagh et al., 2012).
The initiative by the Centers for Medicare and Medicaid Services (CMS) makes reimbursement information open for inpatient and outpatient care. The payment list covers all services and procedures, which are available at a certain hospital. It should also be noted that some states provide performance bonus payments. In general, payment reward for high quality includes reimbursement for improvements, threshold meetings, as well as some other activities and incentives. The direct incentive-based strategies involve the following three mechanisms: tiered premiums or copayments (aligning quality and performance with copayment), pay-for-performance (rewarding for quality enhancement), and centers of excellence (selecting the best performers).
References
Kavanagh, K. T., Cimiotti, J. P., Abusalem, S., & Coty, M. B. (2012). Moving healthcare quality forward with nursingsensitive valuebased purchasing. Journal of Nursing Scholarship, 44(4), 385-395.
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