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In the shift from quantity to quality, there are five critical areas where quality is critical.
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.
Quality care means safe care. Patient safety models are incorporated into value-based care models for obvious reasons, since a major emphasis in these systems is on prevention.
For example, this means that things like preventing secondary infections that could result in preventable hospitalizations can be a key quality measure. This is both an effective cost-saving strategy, as well as a benefit to the patient. An emphasis on providing safe care that prevents extraneous complications is a positive result for both payer and patient.
4. Patient focus
Patients want to feel like they are being listened to and that their providers care about their health and well-being. Patient-centered care checks off these boxes to provide a more fulfilling patient experience. This can also come as a result of increased patient compliance and more effective coordination of care, which is rewarded by value-based care models.
A tricky quality measure to evaluate quantitatively, equitability is nonetheless critical in value-based care models. Equity quality measures encourage providers to provide care to patients from every portion of the population, regardless of demographic.
Many value-based care arrangements put an emphasis on-and reward practitioners for completing-preventative screenings. However, reimbursement is often contingent on screening rates being comparable across these different demographics, which encourages equitable care across all populations.
An important consideration in healthcare equity includes understanding and addressing social determinants of health, such as the economic status of patients. To date, most healthcare equity efforts have centered on community health programs-programs that don’t always meet the standards of care in a value-based payment model.
While value-based care models differ in their emphasis on different quality measures-often due to the needs of the target population-all of them play an important role in every model since they are so interconnected. Only by providing quality care will value-based care models be successful.
Laura Dorr is a freelance writer based outside of Cleveland. She has served as a writer and editor for a variety of publications and websites across the medical, dental, sports, education, and nonprofit industries.