The American Hospital Association (AHA) has elaborated on the first four of 10 “must-do” strategies to move from the volume-based approach to health care reimbursement to the “second curve,” in which providers and practitioners align their efforts to focus on the health of their patient population and are paid for value-based care. Metrics for the Second Curve of Health Care (Metrics) explains the strategies, steps toward their implementation, and how to measure progress.
The strategies were outlined in a 2011 report, Hospitals and Care Systems of the Future, which described the need to move toward a focus on performance and evidence-based practices as the basis for reimbursement moves to a focus on the value of the care provided in terms of its effect on the patient’s health. The four strategies emphasized in Metrics are: (1) aligning hospitals, physicians, and providers to work together across the “continuum of care”; (2) using evidence-based practices to improve quality and patient safety; (3) boosting efficiency through financial management and productivity; and (4) developing integrated information systems.
Alignment Across the Continuum
The first strategy involves a movement of providers and practitioners from separate silos to accountable care organizations (ACOs) or patient-centered medical homes (PCMHs). Success is measured, in part, in terms of the extent to which physicians are engaged in the effort. The expectation is that contracts will include performance-based incentives. The ACO or PCMH will coordinate the care of each patient, emphasizing the management of chronic conditions. Clinicians will increasingly exercise leadership roles.
Use of Evidence-Based Practices
This second strategy includes involving the patient in planning his or her care and paying particular attention to the management of care transitions, such as discharge from hospital to home or rehabilitation, to minimize readmissions and visits to emergency departments. Variations in utilization are measured and analyzed to fill the gaps that may lead to hospital admissions or emergency department visits.
Efficiency, Productivity, and Financial Management
Because reimbursement will be based on an episode of care rather than the volume of services provided, hospitals will have to develop goals to cut costs and manage foreseeable risks. Under performance-based contracts, the providers and professionals operating through ACOs and PCMHs will share the financial risks and any savings generated.
Integrated Data Systems
Patient records will be maintained electronically in an integrated data warehouse. All participants in the continuum of care will have access to the records to have a clear picture of each patient’s needs. In addition, data mining will be used to analyze the health of the patient population as a whole and any emerging disease patterns.
The AHA has developed a survey for providers to use for a self-assessment of their current state and measurement of their progress.