4 must-know facts for health leaders about value-based models

As pressure increases to speed the transition from the fee-for-service model to value-based care, a new report provides four lessons that healthcare leaders can use to maximize quality and value.

The report, conducted by the Avalere Center for Payment & Delivery Innovation and funded by the Robert Wood Johnson Foundation, based their research on a series of questions, including how to define value in healthcare, what available evidence suggests about payment and delivery innovations, and which innovations need further study but show promise in improving healthcare value.

A review of scientific literature found:

Successful value-based models share key characteristics: Researchers found the models that achieved the greatest values feature provider accountability for population health and autonomy in defining the specifics of healthcare value delivery, and ensure providers have the resources and support they need for success in the long term.

A successful delivery transition incorporates clinical and non-clinical population needs: There is a "gap" in healthcare delivery between clinical management of diverse patients and complex medical problems, according to Valerie Overton, vice president of quality and innovation of Fairview Health, which operates both Pioneer and commercial accountable care organizations; providers can help bridge that gap by introducing new types of clinicians, such as community health workers, or redeploying existing ones in non-traditional ways.  

Engagement is essential: Payment and delivery models that personalize delivery to patients' needs and preferences are the most effective newer payment models, researchers found. One way to further this is through patient-reported outcome measures, such as Johns Hopkins University's Patient Activation Measure pilot program, the results of which suggest improved patient engagement boosts patient performance on quality metrics.

New models must incorporate individual markets' circumstances: Ideas for emerging payment and delivery models tend to strive for universal applicability, but Avalere found standardization can restrict chances to tailor those models to specific market and population needs. For example, the Hospital Readmissions Reduction Program, despite successes on a broader scale, operates under a model that tends to penalize high-need providers. One of the biggest potential pitfalls in readmission reduction is "assuming one size will fit all," Ann Hendrich, R.N., Ph.D., senior vice president of quality and safety and executive director patient safety organization at Ascension Health, the largest non-profit health system in the country, told FierceHealthcare.

To learn more:
- download the report (.pdf)