10.Interactive Exercise: Value-Based Care Delivery Review

MODULE 5 | Section 10 of 11

Interactive Exercise: Value-Based Care Delivery Review

WELCOME TO SCOTTSDALE MEMORIAL HOSPITAL*

Scottsdale Memorial Hospital wants to improve its patient care through an initiative to move to value-based health care in several key areas. They’ve asked you to help them identify tools and practices they might implement that will enable them to succeed in this initiative.

Scottsdale Memorial is a fictional hospital.

You decide to start with a survey that you send to all of the clinicians and health care administrators in the hospital. This asks routine questions related to health care and value to serve as a benchmark of their understanding. You’re not surprised to find that the majority of the respondents do not know the basic components of value-based health care. You decide your very first focus needs to be on helping all to understand the basic definition.


Drag and drop the two correct responses to their correct locations in the numerator and denominator of the equation.




=

Value-based health care

=

Outcomes that matter to patients
Total costs of care
Time to complete patient care
Total patient charge
Method of provider reimbursement

NEED A REFRESHER?


Click to revisit

Radar Chart

TDABC

Opportunity Index

(each link will open in a new tab)

Dr. Barbara Malone, the Chief Hospital Administrator, has found that Scottsdale Memorial’s costs of care have been higher than those of its competitors for some time, but isn’t sure of the cause of this. She thinks it’s possible that, due to its proximity to neighborhoods with higher levels of geriatric individuals, the hospital may receive higher-cost patients. However, she also believes that there is a lot of variation between the practices of the clinicians working at the hospital. You agree that identifying where this issue is coming from, will be an important first step. You suggest she use a:


According to some of the clinicians you survey, collecting outcomes is burdensome. The sheer amount of them makes both patients and their doctors frustrated, and it feels like the point of them is to find out what the clinicians did wrong. This is a common feeling, and one that points to a problem with this hospital’s measurement philosophy. Help clear up this misunderstanding by sorting the following statements into their correct locations.




Drag and Drop
To limit patient burden, measures should be taken during treatment and at follow-up appointments only
Patient-reported outcome measures are too burdensome to collect
Measures should reflect every step of the clinical process to be effective.
Measures should be exhaustive to identify the exact causes of issues and outcomes
The amount of measurement should be carefully tailored to the condition
Measure types should be meaningful to the patient’s goals and to clinician learning
Measures should be taken before, during, and following treatment
Measures should be built in to processes so that they are a seamless part of care delivery
Reset tiles
Misconceptions about Measurement
The Goal of Measurement

NEED A REFRESHER?


Click to revisit

Radar Chart

TDABC

Opportunity Index

(each link will open in a new tab)

Through use of the opportunity index scatterplot, it was clear that one physician, Dr. Franks, had higher costs compared to other clinicians. This could mean many things, including that he simply has more complex patients or a higher caseload. After watching him on rounds, however, you notice that he often recommends to patients the most intensive and costly interventions. Although in some selected situations, these options may be most efficacious and clinically appropriate, you haven’t seen him routinely have conversations with patients to explain potential treatment options, alternatives, and to identify goals with his patients. What tool might Dr. Franks use to have these conversations and collaboratively identify the most appropriate treatments based on his individual patients’ goals?


While helping to identify tools surrounding cost analysis and treatment options may help to curb high medical costs and identify areas for improvement, you understand that it doesn’t solve the whole problem. Costs in general are relatively misunderstood by almost all of the clinicians you speak with, who say they often don’t know how to discuss costs with patients. You devise an exercise that will help these clinicians gauge and develop their understanding of costing terminology and reimbursement methods.

For each of the terms, definitions, and descriptions that appear in the center below, drag it to the correct location.



The dollar amount a patient pays out of pocket for a service.
SALARY
Clinicians or health personnel are paid a fixed amount for pre-determined hours or work responsibility.
Does not necessarily incentivize either positive or negative care delivery practices as clinician reimbursement will not change over the course of a year.
The physician or hospital is paid one sum for all services delivered during one illness.
Can be complex when dealing with patients with comorbidities and can incentivize unnecessary care delivery episodes.
COST
The dollar amount that it costs for a provider to deliver a health care service. This includes direct costs, like provider time in diagnosing a disease, or indirect costs, like the use of an OR during surgery.
GLOBAL PAYMENT
A fixed payment is made for all services in a specified time period.
An institution is paid a bundled fee for all services delivered to a patient in a single day.
Clinicians may be incentivized to keep patients in the care institution longer as this will mean higher pay.
CHARGE
The dollar amount a health care provider asks for a service; usually much higher than cost and reimbursement.
The amount an uninsured patient would be asked to pay.
PRICE
The portion an insured patient pays for a hospitalization.
CAPITATION
A specific fee is paid to a health care provider for the provision of a defined package or service in a certain time period to a number of people.
Physicians are incentivized to accept only healthier patients to minimize time spent providing services.
REIMBURSEMENT
The dollar amount a third-party payer (i.e, insurance) negotiates as payment to the provider.
The amount an insurance company pays to a clinic for a patient’s care.
FEE-FOR-SERVICE
Physicians are incentivized to accept only healthier patients to minimize time spent providing services.

A common refrain is that patients get frustrated by everything from aspirin to chemotherapy costing more than they believe it should. Some of the clinicians express that everything would make a lot more sense if they could better understand what actual costs are. A method of costing that accurately measures costs of the clinicians, equipment, space, and overhead used on a minute-to-minute basis in all processes of care for each specific care episode is:


Scottsdale Memorial Hospital is known for its treatment of breast cancer. It has some of the best physicians in the country who specialize in the care and treatment of this condition. After learning about the models you discuss, Dr. Malone is interested in reorganizing the breast cancer treatment ward into an integrated practice unit. Help her identify which of the following elements should be a part of this unit.


Choose all that apply.


Dr. Brady, the best breast cancer oncologist in the unit, needs to be the leader
Those on the IPU team will not need a significant portion of their time for IPU care delivery
The unit must determine a mechanism for routinely measuring and analyzing outcomes and costs
The patient must be at the center of care
The team should include all those involved in the complete care cycle, including support services
A fee-for-service reimbursement model is ideal for the IPU structure

Finally, you find that Scottsdale Memorial is using its health information technology (HIT) mostly for billing. You know that Scottsdale Memorial is not alone and that, while essential in making improvements, two of the most difficult things to do using existing electronic medical records are:


Choose 2.


Record clinical documentation
Provide billing information
Accurately measure true costs to patients
Robustly measure outcomes
Order panels of tests at the same time

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