Volume to Value-Based payment Methodologies

Volume to Value-Based payment Methodologies

Instructions/Descriptions

Volume to Value-Based payment Methodologies

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Moving from volume- to value-based payment methodologies can be challenging due to the cost of implementing them and to the variety of payment structures. The type of value-based program that works for one health care organization may not be the right fit for another. How do you as a health care executive determine the right structure for your organization?

What do you need to take into consideration as you look at shifting from traditional payment methodologies to value-based care?

For this Discussion, review the resources for this week and reflect on the challenges health care executives might face when transitioning the payment methodology in a health care organization to a value-based model. Consider how the move to a value-based model might impact health care delivery for the health care organization.

With these thoughts in mind:

By Day 3

Post an explanation of how you, as a current or future health care executive, would choose a value-based methodology for the health care organization that you currently work in or one with which you are familiar. Describe the organization’s current payment methodology, and explain your rationale for choosing to move to your chosen model. Be specific and provide examples.

Discussion

Continue the Discussion and respond to two of your colleagues (Each Colleagues 250 words or more (Colleague 1 250 words, Colleague 2 250 words, Total 500 words): by providing feedback and recommendations regarding their choices of value-based models and rationales for their choices.

Colleague 1

As a future health care executive choosing the correct value-based methodology is key.  “With the continued rise in the cost of U.S. health care, there is an increased emphasis on value-based care methodologies.  Value is defined as health outcomes achieved per dollar spend” (Galvin, Thompson, Thompson, Parada, Eichinger, Dickens, and Gillingham, 2019).

One organization familiar with is a military program called ‘Tricare’ which is broken into the East and West division. This program provides the health care system in which active, veterans, and family members can receive.

Tricare is a fee for service (FFS) program, according to Galvin, Thompson, Thompson, Parada, Eichinger, Dickens, and Gillingham, “fee-for-service (FFS) In health care, one of the most significant structure measures is the type of reimbursement model in which a health care system utilizes. This payment structure drives and incentivizes all the underlying behaviors within the system” (2019).

In addition, the risk for “FFS systems the financial risk burden lies with the payer because providers are incentivized to over provide services which increases reimbursement.  The military’s use of the Integrated Resourcing and Incentive System (IRIS) along with incentives for good out-comes with the National Surgical Quality Improvement Program (NSQIP) and Joint Outpatient Experience Survey (JOES) are important steps toward providing value-based care.

Universal collection and reporting of patient outcomes, as illustrated by the (Military Orthopedic Tracking Injury and Outcomes) Network MOTION program, and the utilization of integrated practice units, however, hold the promise of dramatically accelerating the value of the care our patients receive and may contribute to the readiness and effectiveness of our nation’s defenders” (Galvin, Thompson, Thompson, Parada, Eichinger, Dickens and Gillingham, 2019).

References

Galvin, J. W., Thompson, J. C., Thompson, A. M., Parada, S. A., Eichinger, J. K., Dickens, J. F., & Gillingham, B. L. (2019). A Guide to Understanding Reimbursement and Value-Based Care in the Military Health System. Military Medicine, 184(3/4), e205–e210. https://doi-org.ezp.waldenulibrary.org/10.1093/milmed/usy206

Colleague 2

As a future health care executive, I would choose a value-based methodology for the health care organization to be more like Kaiser Permanente in California. The mission is to provide affordable, high-quality health care services and to improve the health of the members and the communities. The values statement is “to be the model of quality health care in the nation by being the best place to work and the best place to receive care.” Part of the mission is quality and affordability.

The overriding strategic goal is to pursue ways to trim costs out of the health care delivery process while increasing quality. By concentrating on advanced techniques, including Six Sigma, the health care organization will pursue this strategic objective. The way to influence policy is to first index executive pay to the customer or patient performance.

This will immediately drive greater accountability into the health care organization concerning the patient experience. Then, the policy shift to providing bonuses to operations management teams who drive costs out of health care delivery will also be very effective.

Lastly, the Board of Directors would create a culture of continuous improvement by setting metrics and analytics for company performance that center first on shared information and collaboration. By inventing collaboration, the company’s overall efficiency will significantly improve, and patient satisfaction will also increase.

Reference:

Collins, J.C., & Porras, J.I. (1996). Building your company’s vision and mission. Harvard Business Review, 74, 65

Stewart, T.A. (1996). A refreshing change: Vision statements that make sense. Fortune, 134, 195

Volume to Value-Based payment Methodologies

Volume to Value-Based payment Methodologies

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Volume to Value-Based payment Methodologies

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