The transition to value-based care models from the traditional fee-for-service systems that prioritize quantity over quality has placed new emphasis on what constitutes “quality” in healthcare. Since value-based care reimbursement strategies center around the quality of services delivered, it is critical to identify what exactly that term means—and how it is measured—lest it adversely affect healthcare providers’ revenue streams.
The Agency for Healthcare Research and Quality denotes six domains of healthcare quality, including effective, efficient, timely, safe, patient-centered, and equitable. These measures can be combined and leveraged differently in varying value-based care deals, but are all critical areas for value-based care success, as many contracts require that certain quality measures must be met before payment.
1. Effectiveness and efficiency
Effective and efficient care are a joint effort that centers around ensuring that hospital patients receive proper care and the resources to coordinate future care to reduce readmission rates.
Since it is difficult to measure effectiveness or efficiency directly (as outside factors can affect readmissions or patient health despite a practitioner’s thorough care) many value-based care arrangements instead assess whether or not the provider has taken the appropriate steps to deliver a level of care that could have prevented readmission barring extenuating circumstances. This helps to reinforce a high standard of comprehensive care.
Providing prompt patient care can positively affect patient experience and increase quality of care. Difficulty making appointments, or long wait times to get in for an appointment, can negatively affect patient experience and hinder patient care. Delays in care create challenges in fulfilling the tenants of value-based care models, and can hinger the preventative aspects of the model.