Looking Under the Streetlight? A Framework for Differentiating Performance Measures by Level of Care in a Value-Based Payment Environment
Autor: | James A. Dilling, Stephen J. Swensen, James M. Naessens, Janis M. Orlowski, Paula J. Santrach, Kristine M. Thompson, Robert E. Nesse, Monica B. Van Such |
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Rok vydání: | 2017 |
Předmět: |
Process management
Quality Assurance Health Care Referral Computer science media_common.quotation_subject Population health 030204 cardiovascular system & hematology Education 03 medical and health sciences 0302 clinical medicine Health care Humans Performance measurement 030212 general & internal medicine Reimbursement media_common Operationalization Primary Health Care business.industry Articles General Medicine Payment United States Purchasing Value-Based Purchasing Outcome and Process Assessment Health Care Health Expenditures business Delivery of Health Care |
Zdroj: | Academic Medicine |
ISSN: | 1040-2446 |
Popis: | The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices. In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias. With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions. |
Databáze: | OpenAIRE |
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