Value-Based Care

In 2015 the Department of Health and Human Services (HHS) announced plans to link 30% of Medicare payments to value-based care in 2016 and increase that to 50% by 2018. At the outset, providers were required to switch to a bundled payment model for reimbursement for knee and hip replacements—the most common surgeries for Medicare patients—and given voluntary options, including the Accountable Care Organization, for reimbursement of other services.

Apart from regulatory requirements it remains to be seen how providers will react to calls for value-based care given the added factors of rising medical costs, consumer demand, and traditional reluctance to change in the health care industry.

We believe two of the most important tools in quality improvement for value-based care will be evidence-based clinical pathways and quality measurement tools. Evidence-based clinical pathways are structured care plans for specific conditions that reduce variability and improve outcomes. Quality measurement tools facilitate evaluation of quality improvement initiatives and expose needs-improvement areas.

As opposed to Meaningful Use’s carrot-and-stick approach to clinical decision support adoption, the standardization of care that stands to be realized from these measures naturally lends itself to more sophisticated deployment of clinical content at the bedside and will likely do more to spur adoption of this technology.