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Value-Based Care

2018 Year in Preview
Michael D. Dalzell
Value-based care can’t be done one slice at a time, new value-based models will take aim at variations in care, the patient may gain a stronger voice, the tail could wag the dog, and value-based care will create haves and have-nots. Some predictability from the federal government would be welcome.
Many of today’s value-based care models trace their roots to the Institute for Healthcare Improvement’s Triple Aim. Arguably, their sustainability may hinge on how true they stay to that trinity of improving population health, the patient experience, and per capita costs.
Maybe it’s time to tweak bundled payments, say the authors of an opinion piece in JAMA. They believe that they can be even more cost-effective if their durations are lengthened, if some of the bundled services can be performed outside a hospital, and if they can be integrated with ACOs.

Choosing the right blend of quality metrics for each DRG is one of the many intricacies of Value-Driven Outcomes (VDOs), Utah’s answer to the challenge of how to “do” value-based care. An initiative five years in the making, VDO matches indicators of quality to DRGs with substantial variation in cost within Utah’s own system.

Researchers at the University of Texas MD Anderson Cancer Center noted that in recent years there has been a marked increase in bilateral mastectomy and reconstruction for early breast cancer. “While some of these procedures are clearly medically indicated, the choice for mastectomy is often driven by nonmedical factors….”
Michael D. Dalzell
No real trends in quality improvement or cost savings have emerged, while mortality outcomes have remained flat. The program withholds 2% of hospitals’ Medicare pay and redistributes most of it to high-performing hospitals. With so little money at risk, the program simply may not turn enough heads.
The Rise and Fall of the Oncology Medical Home
There is a lot of heavy lifting between now and then, but many of those who think about cancer care payment reform for a living see episode payments as the finish line.
High drug costs are a cause célèbre. Executives at Harvard Pilgrim Health Care have responded with value-based contracts for two expensive medications, etanercept (Enbrel) and teriparatide (Forteo). Michael Sherman, MD, Harvard Pilgrim’s chief medical officer, said in the news release that “real world performance of new medicines frequently differs from the well-controlled clinical trial setting….”