Part I
Moving from volume- to value-based payment methodologies can be challenging due to the cost of implementing them and to the variety of payment structures. The type of value-based program that works for one health care organization may not be the right fit for another. How do you as a health care executive determine the right structure for your organization? What do you need to take into consideration as you look at shifting from traditional payment methodologies to value-based care?
Review the resources for this week and reflect on the challenges health care executives might face when transitioning the payment methodology in a health care organization to a value-based model. Consider how the move to a value-based model might impact health care delivery for the health care organization.
EXPLAIN IN 2 OR 3 PARAGRAPHS HOW YOU, AS A CURRENT OR FUTURE HEALTH CARE EXECUTIVE, WOULD CHOOSE A VALUE-BASED METHODOLOGY FOR THE HEALTH CARE ORGANIZATION THAT YOU CURRENTLY WORK IN OR ONE WITH WHICH YOU ARE FAMILIAR. DESCRIBE THE ORGANIZATION’S CURRENT PAYMENT METHODOLOGY, AND EXPLAIN YOUR RATIONALE FOR CHOOSING TO MOVE TO YOUR CHOSEN MODEL. BE SPECIFIC AND PROVIDE EXAMPLES.
PART II
HOW MIGHT HEALTH CARE EXECUTIVES CHOOSE A VALUE-BASED CARE MODEL FOR THEIR ORGANIZATION? WHAT WOULD YOU, AS A CURRENT OR FUTURE HEALTH CARE EXECUTIVE, NEED TO CONSIDER IN MAKING THIS CHOICE? ARE THERE OTHER LEADERS WITHIN YOUR ORGANIZATION WHO YOU WOULD WANT TO INVOLVE IN MAKING THIS DECISION?
QUESTIONS SUCH AS THESE ARE CRITICAL FOR YOUR ROLE AS A CURRENT OR FUTURE HEALTH CARE EXECUTIVE. ENSURING THAT YOUR ORGANIZATION MAKES THE BEST CHOICE OF A VALUE-BASED CARE MODEL, WHILE INFORMING THE BOARD OF DIRECTORS AND OTHER DEPARTMENTS, IS A CRITICAL RESPONSIBILITY OF YOUR ROLE. PRACTICE IN DEVELOPING EXECUTIVE BRIEFS THAT MAY BE PRESENTED TO THE BOARD OF DIRECTORS FOR A HEALTH CARE ORGANIZATION IS MEANINGFUL IN HELPING GUIDE NECESSARY AND SUFFICIENT INFORMATION TO ENACT INITIATIVES FOR HEALTH CARE DELIVERY.
CONSIDER HOW YOU, AS A CURRENT OR FUTURE HEALTH CARE EXECUTIVE WOULD CHOOSE A VALUE-BASED CARE MODEL FOR YOUR HEALTH CARE ORGANIZATION. REFLECT ON THOSE KEY POINTS THAT YOU WOULD HIGHLIGHT AS MOST CRITICAL IN AN EXECUTIVE BRIEF FOR YOUR BOARD OF DIRECTORS.
THE ASSIGNMENT: (1–2 PAGES)
- WRITE AN EXECUTIVE BRIEF THAT YOU WOULD PRESENT TO THE BOARD OF DIRECTORS THAT HIGHLIGHTS YOUR CHOICE OF VALUE-BASED CARE MODEL. PROVIDE YOUR RATIONALE FOR CHOOSING THIS MODEL OVER OTHERS FOR YOUR ORGANIZATION.
- BE SURE TO INCORPORATE FEEDBACK AND RECOMMENDATIONS SUGGESTED BY YOUR COLLEAGUES IN THIS WEEK’S DISCUSSION.
References:
Gehardt, W., Korenda, L., Morris M., & Vadnerkar, G. (2015). The road to value-based care: Your mileage may vary. Westlake, TX: Deloitte University Press.
Hundange, I. V., Riner, N., Aagard, M., & Riner, R. (2016). Adopting new cardiovascular models to achieve value-based care. Physician Leadership Journal, 3(2), 34–42.
Miller , H. D. (2009). From volume to value: Better ways to pay for health care. Health Affairs, 28(5), 1418–1428.
VanLare, J. M., & Conway, P. H. (2012). Value-based purchasing—national programs to move from volume to value. The New England Journal of Medicine, 367(4), 292–5.
Expert Solution Preview
Introduction:
Transitioning from traditional payment methodologies to value-based care can be challenging for healthcare organizations. As a healthcare executive, it is important to determine the right structure for your organization while considering the various payment structures and implementation costs. In the following paragraphs, I will explain how to choose a value-based methodology for a healthcare organization and how the move to a value-based model might impact healthcare delivery.
Part I:
As a healthcare executive, choosing a value-based methodology for a healthcare organization requires careful consideration of the organization’s current payment methodology and specific factors that currently affect the organization’s operations. For example, a healthcare organization’s current payment methodology may be fee-for-service, which is a payment model based on the number of services provided. This method lacks incentives to manage and prevent illnesses, leading to increased healthcare costs and inefficiencies.
Moving to a value-based model requires that the healthcare executive look for a model that will motivate the healthcare team to provide high-quality care while effectively reducing costs. Therefore, I will choose the patient-centered medical home (PCMH) model, which is a primary care model that provides comprehensive, coordinated, and accessible services to patients. In the PCMH model, the healthcare team coordinates with patients’ needs, creating a continuous relationship between the patient and the healthcare team. The PCMH model aims to enhance the patient experience while reducing healthcare costs.
Part II:
Choosing a value-based care model for a healthcare organization requires a comprehensive analysis of the organization’s strengths and weaknesses. A healthcare executive would need to consider various key points such as the organization’s current payment model, available resources, patient population, and the healthcare team’s willingness to adapt to the new model. Additionally, a healthcare executive would need to understand the organization’s culture and how the new model would affect it.
An additional point to consider is the involvement of other leaders within the organization to aid in decision-making. It is beneficial to involve other departments such as finance, operations, and clinical staff as they help provide important information that shapes the decision-making process. A healthcare executive would also need to ensure that these leaders are adequately informed about the new model’s details and how it would potentially impact the organization’s operations.
Executive Brief:
I propose the adoption of the PCMH model as a value-based care model for the healthcare organization. The current fee-for-service payment model does not promote high-quality healthcare, leading to increased healthcare costs and inefficiencies. The PCMH model aims to provide comprehensive, coordinated, and accessible services to patients while enhancing the patient experience and reducing healthcare costs. The adoption of this model will require the involvement of other leaders within the organization to promote effective decision-making while ensuring that they are adequately informed about the necessary details of the new model and its prospective impacts.
