Era Of Value-based Care Research Articles

Mammography Performance Benchmarks in an Era of Value-based Care.

Mammography Performance Benchmarks in an Era of Value-based Care.

Direct-to-Consumer Medical Testing in the Era of Value-Based Care.

This Viewpoint documents the growing market share of direct-to-consumer (DTC) medical testing despite growing recognition that it represents low-value or harmful care and proposes policy options to increase accountability and protect patients from adverse consequences of DTC testing.

Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems.

The demand for healthcare is rising due to aging populations, rising chronic disease prevalence, and technological innovations. There are currently more effective and cost-effective interventions available than can be afforded within limited budgets. A new way of thinking about the optimal use of resources is needed. Ensuring that available resources are used for interventions that provide outcomes that patient’s most value, rather than a focus just on effectiveness and cost-effectiveness, may help to ensure that resources are used optimally. Value-based healthcare puts what patients value at the center of healthcare. It helps ensure that they receive the care that can provide them with outcomes they think are important and that limited resources are focused on high-value interventions. In order to do this, we need flexible definitions of ‘health’, personalized and tailored to patient values.We review the current status of value-based health care in England and identify lessons applicable to a variety of health systems. For this, we draw upon the work of the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS), Right Care Initiative, and our local experience in promoting value-based health care for specific conditions in our region. Combining the best available evidence with open and honest dialogue between patients, clinicians, and others, whilst requiring considerable time and resources are essential to building a consensus around the value that allows the best use of limited budgets.Values have been present in healthcare since its beginnings. Placing value and values at the center of healthcare could help to ensure available resources are used to provide the greatest possible benefit to patients.

Defining Health in the Era of Value-Based Care: The Six Cs of Health and Healthcare.

Introduction: While healthcare expenditure continues to increase overall health outcomes in the United States continue to be submarginal. The changes we make in our healthcare system need to be informed by a comprehensive and actionable definition of health that can unite patients, healthcare professionals, and policymakers.Methods: A literature review across multiple disciplines was conducted to assess a broad range of factors associated with health and well-being and based on this literature review a novel definition of health was developed.Results: Development of a definition of health as the ability to dynamically recognize and resolve dissonance in one’s physical, mental, social and spiritual worlds via cooperation with social and spiritual connections, the medical community and with the natural world in a way that fosters and promotes harmony, resilience, and relief from suffering. This definition is then expanded into six domains (connection, communication, creativity, cooperation, cost-consciousness, and computerization) which are applicable to individuals, society and the healthcare system and which form the basis for actionable guidelines to promote measurable and sustained change on a public health scale.Conclusion: Healthcare in the United States is changing and in order to move forward in an evidence-based and compassionate way, we need to understand what we mean by 'health' and how that definition can be operational at individual, societal, and public policy levels.

The Meaning of Health in the Era of Value-based Care.

In an era of value-based care, the practice of medicine and other health professions have been drawn to subjective, comprehensive and multidimensional views of health such as the World Health Organization(WHO) concept that defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. This paper, through a philosophical analysis, demonstrates that health is not multidimensional and is a natural phenomenon. A philosophical discussion contends that health must realistically and logically reside in the person and this requires it to be a physical state. This paper also illustrates that, in the popular language of health, many times, health professionals: (1) inappropriately view health as a subjective human construct as opposed to viewing health as an objective phenomena, (2) confuse what is desired and valued as a good life with what is good health, and (3) fail to recognize the vital distinction between what affects health and what is health. A meaning of health is offered through several examples and arguments that demonstrate why health is a state of physical well-being or physical fitness that is defined by how well the body is functioning in accordance with its natural design and how well this natural design affords individuals the ability to achieve essential functional objectives of humans on the biological and person level.

Goal-Directed Health Care: Redefining Health and Health Care in the Era of Value-Based Care.

Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined. If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. The role of patients within clinician-patient relationships would be elevated, strengthening therapeutic relationships. Reframing health in terms of health-related goals and directing the health care system to help people achieve them, could both improve quality and reduce costs. In the process, it could also make health care less mechanical and more humane.

Cutting the Stone: Health Defined in the Era of Value-based Care.

The immune system contributes to the maintenance of health by preventing and limiting the clinical consequences of infections by pathogenic microorganisms. During the evolution of Homo sapiens, those with the fittest immune system survived. The immune system of Homo sapiens was further improved and adapted by admixture with Neanderthal genes. Nowadays, the human immune system provides adequate protection against the majority of infections. For some 20 infectious diseases, the immune system needs to be improved by vaccination. Vaccination is the number one value-based healthcare intervention and has resulted in global eradication of smallpox. Eradication of poliomyelitis and measles is within reach. A continuous effort will be required for recently emerged pathogens, such as Ebola and HIV, as well as the most difficult - malaria and tuberculosis.

The Use of Patient and Family Advisory Councils to Improve Patient Experience in Radiology.

Rising costs and widespread inefficiencies in current practices have prompted a paradigm shift in American health care from volume- to value-based care with patients and families assuming a central role. Patient and family advisory councils (PFACs) are particularly compelling as a strategy for using patient and family engagement for process improvement. Although relatively new in the radiologic community, PFACs can be a powerful tool in improving patient experience. PFACs are a particularly powerful method of patient and family engagement that can be used in effecting meaningful change in practice. This valuable resource resides within most hospitals and is generally readily accessible. In the era of value-based care, it is essential that radiologists actively engage with patients to improve efficiency, reduce expenditures, and maximize patient satisfaction.

Urology Group Compensation and Ancillary Service Models in an Era of Value-based Care.

Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations.

Training the next generation of doctors in palliative care is the key to the new era of value-based care.

There is a common misperception that palliative care is just another term for hospice care. Although it includes hospice, palliative care is also the long-term coordinated care of the chronically ill, which is delivered at a cost savings. Why does it matter that the average American understand what palliative care means? Because the evidence shows that U.S. patients near the end of life are spending exorbitant amounts of money on health care they do not want and the country cannot afford. To better understand why palliative care is an important issue in the current debate about health care reform, the authors first briefly review landmark legal cases in the area of end-of-life care. They then discuss the role of palliative care in conversations in the current health care climate and conclude by emphasizing the importance of integrating palliative care into the standard medical curriculum. The authors predict that palliative care will be accepted in the United States as a much-needed and desirable field of medicine. Getting there, however, will require a multifaceted approach including payment reform, encouraging an open conversation among the U.S. public, and training physicians to offer the best possible care and guidance until a patient's last breath.

How (and why) do quality improvement professionals measure performance?

The era of value-based care has engulfed healthcare delivery systems around the world. Pediatricians are especially challenged by constrained resources for providing care to our vulnerable population, and methods for achieving value for children through improved quality and reduced cost of care are crucial for success. This paper examines the use of measures to determine the two components of the value proposition: quality and cost. The implications for adopting Lean Six Sigma as an improvement paradigm are reviewed, and the case for using these concepts is detailed with examples of measures used in health systems in the United States and several other countries.

Medical consultation for surgical cases in the era of value-based care.

18. Wijeysundera DN, Austin PC, Beattie WS, Hux JE, Laupacis A. Outcomes and processes of care related to preoperative medical consultation. Arch Intern Med. 2010;170(15):1365-1374. 19. Wijeysundera DN, Austin PC, Beattie WS, Hux JE, Laupacis A. Variation in the practice of preoperative medical consultation for major elective noncardiac surgery: a population-based study. Anesthesiology. 2012;116(1):25-34.

Reply to M.C. Chamberlain

regard to the safety of HA-WBRT, previous work by Gondi et al 4 evaluating 1,133 metastases in 371 patients revealed perihippocampal lesions in 8.6% of patients. Moreover, only 4.5% of patients who developed intracranial progression in Radiation Therapy Oncology Group trial RTOG 0933 progressed in the hippocampal-avoidance area. 2 Therefore, for the vast majority of patients undergoing WBRT, HA would be associated with a low risk of compromising intracranial disease control. Next, patients with a good performance status (Karnofsky performance status 70) and favorable long-term prognosis would likely benefit most from this technique and were specifically enrolled onto this trial. As a result of advancements in imaging techniques, better availability of and access to health care resources, and improvement in systemic therapies, we suspect that the proportions of these patients with favorable risk will continue to increase. Another concern raised addresses the role of HA-WBRT in the current era of stereotactic radiosurgery (SRS) given that focal therapies are quickly becoming the primary and adjuvant treatment of choice for patients with brain metastases. The updated National Cancer Center Network 2015 guidelines recommend either WBRT or SRS alone as primary treatment options for patients with multiple lesions ( 3 lesions). Despite the increasing adoption of primary SRS, randomized phase III trials have clearly demonstrated that the addition of WBRT improves local control and distant brain failure, minimizes the need for salvage therapies, and most importantly, decreases neurologic death. 5 Therefore, HA-WBRT may offer an attractive alternative treatment, especially in patients with a high probability of distant intracranial failure, with a reduced risk for neurocognitive deterioration. Over time, cooperative group trials in patients with brain metastases have transitioned from evaluating survival as the primary end point to focus on neurocognitive metrics. This was clearly fueled by additional analyses of the trials by Chang et al 6 and Kocher et al, 7 which demonstrated a decline in the Hopkin’s Verbal Learning TestRevised results and cognitive functioning, respectively, in patients who underwent WBRT. To compare their work with the previous research in this domain, Gondi et al 2 specifically evaluated a change in results measured by the Hopkin’s Verbal Learning Test-Revised as the primary end point for RTOG 0933. This decision was also supported by previous research by Li et al 8 who determined that memory function, unlike other neurocognitive domains, continued to decline after WBRT despite tumor shrinkage. Although a more complete battery of tests would be interesting to analyze, choosing the specific test that has been uniquely linked to neurocognitive deterioration after WBRT and used in previous studies has the advantage of being feasible and practical for study. Ultimately, the discovery of a reliable biomarker that correlates with neurocognitive functioning would allow survival to also be a recognized end point in future trials. In the current era of value-based care, cost-effectiveness studies are clearly needed when multiple treatment options exist. 9 In one of the few studies on this topic, Lal et al 10 used the economic data from the trial by Chang et al 6 to demonstrate the cost effectiveness and cost utility of primary SRS with observation when compared with SRS with WBRT. Although SRS with observation was associated with a higher cost, it was also associated with a higher effectiveness and cost effectiveness, even when considering additional salvage therapies, with a gain of cost per life-year well within the standards for other medical therapies. As more experience and economic data are generated in association with HA-WBRT, similar types of analyses will generate useful comparative data. In all, given the scrutiny on costs, future trials