High-value care is about much more than containing costs. It’s also a recipe for improving patient outcomes, safety and satisfaction. But what exactly is it and how is it measured?
An education module offered via the AMA Ed Hub™ helps medical students understand the concept of value and how it applies to health care. It also gives insights into the current state of value in U.S. health care, describes the essential components of—and barriers to—an ideal patient-centered, high-value health care system, and outlines specific ways physicians can promote high-value care.
The AMA Ed Hub is an online platform with high-quality CME and education that supports the professional development needs of physicians and other health professionals. With topics relevant to you, it also offers an easy, streamlined way to find, take, track and report educational activities.
The free online CME module—“What Are the Components of Value-Based Care?”— is one of 13 recently revised modules released as part of the AMA Health Systems Science Learning Series. The modules also are available to subscribers of the AMA UME Curricular Enrichment Program, which enables educators to assign specific elements and receive reports on student progress, track via a dashboard, send reminder emails and customize reporting options.
Essential concepts
Ways to define value. The National Academy of Medicine has developed a widely accepted approach that describes high-value health care as: safe, timely, effective, efficient, equitable and patient-centered—STEEEP for short. The Institute for Healthcare Improvement later translated this into a framework for action, the Triple Aim, which is made up of better patient outcomes, improved patient satisfaction and lower costs. The Triple Aim has since been expanded to the Quintuple Aim, which includes physician and health professional well-being and health equity.
How to measure it. The health care value equation provides a way to understand how well an organization is performing vis-a-vis the vision of STEEEP and the framework of the Triple Aim. It is defined as the quality of care—made up of outcomes, safety and service—divided by the total cost of patient care over time.
Value is variable. The U.S. health system produces some of the best outcomes in the world, but also some of the worst, as measured by mortality amenable to health care. For example, the top five U.S. states would consistently rank near the top of developed countries, whereas the bottom five would trail them all.
Dive deeper:
- 7 keys to success with value-based care pay arrangements
- 5 ways to improve data sharing and advance value-based care
Ways to improve
An ideal high-value health care system features six key components: a clear, shared vision with the patient at the center; leadership and professionalism of health care workers; a robust IT infrastructure; broad access to care; and payment models that reward quality improvement over volume. But the U.S. health care system was never deliberately designed to include these attributes.
Physicians play crucial roles in moving the health care system toward this model by minimizing low-value care and focusing on care that is high value and necessary. The first step is to identify and classify gaps that lead to waste, errors and missed opportunities. These include overuse, when care has a greater potential for harm than benefit; misuse, when appropriate care is selected but results in preventable complications; and underuse, when opportunities to provide high-value care are missed.
Dive deeper:
- Future of sustainable value-based care: Best practices for payment methods
- Succeeding in value-based care: Best practices for data sharing
Future of value-based care
As part of its aggressive campaign to fix the unsustainable Medicare physician payment system, the AMA has outlined in a quick, easily navigable fashion the policy changes needed to realize the robust physician pathway to alternative payment models (APMs) that Congress envisioned.
The AMA’s two-page explainer on advancing value-based care with APMs (PDF) details how there are far fewer opportunities for physicians to participate in Medicare APMs than Congress foresaw under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
While the goal was to give most doctors a chance to transition into APMs, the Center for Medicare & Medicaid Innovation “models implemented to date often have steep financial risk requirements, lack funding needed to successfully redesign care delivery, and are usually only available in selected regions,” the AMA explains.
Nearly a decade since MACRA’s passage, it is clear that critical changes are needed to enhance physician participation in APMs, improve patient outcomes and cut unnecessary Medicare spending.
Learn more with the AMA about why value-based care’s future rests on reforms to Medicare APM incentives
