M5: Value-based payment reform
13 important questions on M5: Value-based payment reform
Do the following payment methods lead to overprovision or underprovision?
- FFS
- Capitation
and does the payment method 'salary' lead to high quality?
And what about: risk selection, prevention, and productivity?
- Stimulates overprovision
- discourages prevention
Capitation:
- stimulates underprovision
- triggers risk selection
Salary:
- no incentive for high-quality
- no incentive for productivity
Value is a multidimensional concept, but what are the four key value dimensions?
- High quality care:
- 'Technical' quality and patient satisfaction
- Cost-conscious behaviour:
- Scarce resources are efficiently used
- Well-coordinated care:
- Providers from different disciplines communicate and cooperate well in order to realise integrated care across the continuum of care.
- Prevention:
- (deteriorations of) health problems are prevented (in a cost-effective way)
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VBP consists of two core components, explain these. How are they linked to P4P and capitation?
- Global base payment:
- Capitation with implicit incentives for value aspects that are not measurable.
- Small variable payment
- P4P (top iceberg) that explicitly rewards measurable aspects of value
Which value dimensions are incentivized by the components of VBP?
Global base payment: cost-conscious behaviour, well-coordinated care, prevention.
Give five key features of a theoretically optimal base payment. Explain per feature what it stimulates
- Is an integral payment to a multidisciplinary provider group: to stimulate well-coordinated care.
- Covers a cohesive set of care activities to a predefined population: to stimulate prevention and holistic care.
- Is fixed for a defined period of time: to stimulate cost conscious behaviour.
- Is adjusted for the risk-profile of the target population: to prevent undesired behaviour that may thwart value.
- Includes risk-mitigating measures for healthcare providers: to prevent undesired behaviour that my thwart value.
What is the payment method for Alternative Quality Contract (AQC) & Medicare Shared Savings Program (MSSP)?
How is the target/payment set?
Name three features.
What is the contract duration for AQC and MSSP?
Features:
- Historical spending
- AQC past 3 years, negotiable and MSSP past 3 years
- Relative cost benchmarks market or peers
AQC = 5 years
MSSP >= 3 years
Is there a one or two-sided risk for AQC & MSSP?
MSSP: depends on Track
Give four reasons why there is great potential to enhance value:
- Deficiencies and variation in quality of care exist.
- The level of spending growth on health care is unsustainable
- The delivery system is fragmented
- Lacking incentives for (primary) prevention
Value-based payment (VBP) reform is a crucial element in the pursuit of VBHC. Why? Give 3 reasons.
- Financial incentives are always present in any sector of economy
- Providers respond to financial incentives and can influence demand
- Providers do not always act as perfect agent of patients
Although financial incentives are important, not all incentives are financial
Limitations of bundled payments (4x)
- Designing bundled payments is a complex undertaking
- Payment is still volume-based
- Incentives for cost-consciousness and coordination are condition- or treatment-oriented and do not apply to the whole person
- Evidence regarding (cost-)effectiveness is limited
Give three purposes of riskadjustment
- Fairness in payment allocation
- ACOs willingness to accept high-risks
- ACOs focusing fully on optimizing value
Which (mixture of) payment method(s) would be suitable for stimulating both cost containment and high quality of care? Explain your answer
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