Pharmacy OneSource Blog

How Value-Based Care and Value-Based Purchasing Affect Provider Care

Posted on 02/17/16

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Value-based care (VBC), also known as accountable care, represents a shift away from the traditional medical model where individual health events are treated.The goal of value-based care is for physicians and the entire healthcare team to focus on a patient’s overall health, lower healthcare costs, and improve quality and outcomes. U.S. health care, while excellent, is too expensive, many times inefficient, and the quality of care can be quite varied. There is a shift in healthcare to focus on  care quality and patient outcomes: quicker recoveries, fewer readmissions, lower infection rates, and fewer medical errors, to name a few.2

Value-Based Purchasing (VBP) is a type of pay-for-performance model and has been adopted into CMS programs to help support and deliver VBC. Basically, VBP involves the actions of many entities - coalitions, employer purchases, public sector purchases, health plans, and individual consumers - in making decisions that should consider factors such as access, price, quality, efficiency, and alignment of incentives. Healthcare providers that are high-performing and effective are rewarded with improved reputations through public reports, enhanced payments through reimbursements, and increased market share through purchase, payer, or consumer selection.VBP focuses on the care a patient receives at the individual level, rewarding providers for the quality and outcome of care provided instead of the number of patients seen in a day. The care of the patient is integral, physicians and healthcare systems are paid for keeping their patients healthy.

But how is quality measured? For those in infection prevention and control, one way to improve quality is to reduce the risk of hospital-acquired infections. For the hospital overall, there are many other hospital-acquired conditions that require administration’s attention.

Data collection and analysis is critical to this endeavor; part of the problem hospitals face is the myriad of IT systems in their facilities, including pharmacy, laboratory, the electronic medical record, emergency room, operating room, etc. Can these systems “talk” to each other so that data can be retrieved and reviewed efficiently?

VBC focuses on better coordination of healthcare services so that systems, results, and records are integrated. For example, have you ever been a hospital patient and have been asked the same questions by five different people? What about transitioning from one shift or service to another, what is lost in translation? Examples of VBC plans could include:4

  • Managing data from multiple players
  • Managing transitions in care to identify and close gaps
  • Implementing effective and evidence-based care plans
  • Providing systems for infection prevention and control to electronically manage surveillance and integrate with pharmacy
  • Optimizing pharmacy spending by reviewing antibiotic usage and route of administration

Value-based care and value-based purchasing have the same goal: to provide the best quality of care to the patient. VBC will help hospitals achieve the metrics needed to get the best reimbursements from Medicare’s VBP.

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References:

  1. Business Wire. Accessed December 28, 3015: http://www.businesswire.com/news/home/20151215005166/en/Collaborative-Health-Partners-Humana-Team-Value-Based-Care

  2. Harvard Business Review. Value-Based Health Care Is Inevitable and That’s Good.September 24, 2013. Accessed January 28, 2016: https://hbr.org/2013/09/value-based-health-care-is-inevitable-and-thats-good?cm_sp=Article-_-Links-_-Top%20of%20Page%20Recirculation

  3. Value-Based Purchasing Guide. National Business Coalition on Health’s Value-Based Purchasing Council. Accessed December 28, 2015: http://www.nbch.org/Value-based-Purchasing-A-Definition

  4. McKesson Population Health Management. Succeeding with Value-Based Care Models. Accessed December 28, 2015: http://www.mckesson.com/population-health-management/solutions/succeed-with-value-based-reimbursement-models/

Topics: Antimicrobial Stewardship

About the Author

Deb Oroszlan is the Marketing Director for Pharmacy OneSource - Wolters Kluwer.