Value-based payment models aim to increase value by improving outcomes and lowering costs. Though there are many possible approaches to achieve this aim, most models use some combination of care coordination and financial incentives/penalties tied to quality metrics. The reading provides a general overview of the types of value-based payment models.
Familiarize yourself with the definitions of cost and waste and their relationship to value.
This module will introduce the definitions of cost and waste as well as their relationship to value. A key point is that cost can mean more than just financial impact so pay special attention to the downstream effects of a low-value intervention on a patient.
Search the Khan Academy website (khanacademy.org) and create a log-in. Locate the “Health Care System” modules. To do this, first select the “Science” category, then “Health and Medicine”, then “Health Care System”. All students should arrive to class capable of quickly accessing the Khan Academy website.
View Khan Academy Modules as necessary. Three Khan academy modules are listed below. The content of these modules is summarized. Students with background knowledge in the listed content and fact sheet content are NOT required to view the modules. The modules are a supplementary assignment and should be completed as necessary based on student background and understanding of the US healthcare system and payment systems. Note: students may need to access Khan Academy modules for small group work during the breakout session.
Explains how patients/populations, providers, and payors interact. Introduces government insurance, direct payment of patient to doctor, HMOs and PPOs. Explains the rationale for insurance to mitigate risk and discusses the need to manage “moral hazard” as well as over-utilization of services when not directly responsible for payment.
Defines FFS, capitation and salary. Describes the lack of cost accountability to patients and providers in the third party payor system. Describes issues with capitation with particular attention on “cherry picking” or patient shifting.
Introduces Medicare and Medicaid. Defines populations covered for Medicare (Elderly/ALS/ESRD) and Medicaid (low income) as well as funding source (Federal Government for Medicare and combined Federal and State for Medicaid). Defines Secretary of HHS and CMS (Centers of Medicare and Medicaid Services). Describes Medicare parts A-D.
McLeroy, Bibeau, Steckler and Glanz are generally credited with creating the social ecological model of care. A quick Google search for the social ecological model will reinforce how widely it has been adopted. There are numerous community, state, national and international organizations that utilize this model in their programs.
Think back to your session in immersion on the social history. How often do you think beyond the individual and interpersonal factors that influence you and your patients health?
Fiona Goodlee, editor of the British Medical Journal and the editorial staff at The Lancet have both written editorials about the evolving definition of health. Click on the below links to read the two articles. Read the articles with the below questions in mind.