Plans for implementing healthcare policies are essential for reaching the intended medical results. These programs aim to increase access to care, raise the standard of care, and lower healthcare costs. Value-based buying (VBP) initiatives are one such strategy for policy implementation (Hickman et al., 2022). VBP initiatives are intended to encourage healthcare professionals to offer high-quality care by linking payments to results. With this payment structure, providers are incentivized to prioritize the quality of treatment rather than the quantity of services rendered. This essay aims to select and thoroughly describe one particular value-based purchasing model. It will examine how putting this policy into place might increase access to treatment, raise the standard of care, and lower healthcare costs. This study will offer a deeper comprehension of the mechanics behind value-based care, its advantages, and the difficulties encountered during implementation by concentrating on a specific VBP program (ŞİMŞİR & Altındiş, 2019). This study aims to shed light on how VBP programs might completely transform the healthcare sector.
Bundled Payment Programs
Value-based purchasing (VBP) programs called bundled payment programs offer a single payment for a group of connected services or procedures rather than charging for each separately to increase care quality while cutting costs. Healthcare providers are encouraged under this paradigm to cut expenses by providing care effectively and adhering to high standards. A few services bundled payment programs can cover surgical operations, hospital stays, and post-acute care.
Healthcare providers in bundled payment programs oversee the cost and caliber of care for a particular episode of care, which often entails all services connected to a particular procedure or hospitalization. All services associated with that episode of care, including hospitalization, physician services, and any further auxiliary services that might be required, are covered by the upfront payment (Hickman et al., 2022). Through bundled payment systems, healthcare providers are encouraged to work together to improve patient outcomes and reduce costs. This model prioritizes the quality of care provided over the quantity of services. Providers are urged to reduce costs by delivering efficient care, reducing unnecessary services, and shortening hospital stays.
Healthcare providers’ administrative load and financial security can be improved using bundled payment programs offering a predictable payment structure. One of their primary benefits is this. To further improve patient outcomes and decrease unnecessary readmissions, the bundled payment model encourages collaboration among doctors to coordinate care across the entire episode of care (MR & Altndiş, 2019). Bundled payment plans have been used in many healthcare settings, such as Medicare and Medicaid. Although implementing bundled payment schemes can be challenging, they are a viable technique for value-based purchasing in healthcare because of their potential to expand patient access to care, improve the quality of care provided, and reduce healthcare costs.
Bundled payment systems as a value-based purchasing (VBP) technique may improve healthcare access, quality, and affordability. By incentivizing clinicians to offer care that is both effective and efficient, bundled payment arrangements can increase patients’ access to treatment. This is especially important for those patients who cannot afford therapy or lack access to necessary resources. Bundled payment plans can make care more affordable and accessible by motivating providers to reduce costs and improve efficiency (Walters et al., 2019). Providers can be rewarded through bundled payment plans to provide interventions and treatments, such as joint replacements, that reduce patients’ total healthcare expenses.
Bundled payment agreements can improve the quality of service by encouraging healthcare providers to collaborate and coordinate their efforts. Clinicians are incentivized to work together under the bundled payment model (Walters et al., 2019) to give patients a more streamlined and efficient treatment episode. For instance, a bundled payment structure for stroke therapy could improve results by encouraging collaboration between hospitals and post-acute care providers to ensure patients receive prompt and appropriate treatment across the continuum of care.
By rewarding efficiency and discouraging waste, bundled payment models can reduce the overall cost of treatment. Providers are more willing to forego less effective treatments when paid a flat charge for each episode of care. Individuals and health insurance providers alike may benefit from this in the long run. By incentivizing doctors to adopt data-backed operations and limiting the use of costly medical devices, bundled payment plans, like those for knee replacements, can reduce healthcare spending. In 2016, CMS introduced a new paradigm of care called Comprehensive Care for Joint Replacement (CJR). This is an excellent example of a bundled payment scheme (Hickman et al., 2022). This program incentivized medical facilities to give people who need hip or knee replacements high-quality care at lower costs.
According to the CJR model, hospitals were responsible for the total cost and quality of care for a patient’s entire episode of care after a joint replacement, and they had to take part in a bundled payment scheme. Since it was first used, the CJR plan has been shown to improve care while lowering costs. One study showed that hospitals that participated in the CJR program saved an average of $1,166 per joint replacement episode of care by cutting costs by 3.3%. Joint replacements, heart attacks, and pneumonia were just some of the conditions and treatments targeted by this initiative, which attempted to reward healthcare professionals for minimizing the cost of care for these and other conditions and operations (ŞİMŞİR & Altındiş, 2019). Providers received financial incentives to improve efficiency without sacrificing the quality of care under this scheme. The BPCI project has been proven effective in lowering healthcare expenses and raising the standard of service in multiple studies. According to one research, patients receiving joint replacements saved 20% on average thanks to the BPCI program without sacrificing quality. Reduced reliance on post-acute care services is further evidence that the program improved the quality of care providers provide.
Conclusion
Value-based buying (VBP) schemes, such as bundled payment models, can improve healthcare access, quality, and affordability. Healthcare providers can enjoy less paperwork and financial security thanks to the bundled payment program’s predictable payment structure. Bundled payment agreements can improve patient outcomes and reduce readmissions by promoting collaboration among clinicians (Hickman et al., 2022). Healthcare providers are incentivized by bundled payment arrangements to provide services that reduce their patients’ healthcare expenditures. One such bundled payment approach that has been shown to improve care while cutting costs is the Comprehensive Care for Joint Replacement (CJR) program. Bundled payment plans have the potential to benefit patients, providers, and payers; nevertheless, their implementation can be complex.
References
Hickman, S. E., Cole, C. S., & Unroe, K. T. (2022). Leveraging Value-Based Purchasing to Improve Advance Care Planning. Journal of Gerontological Nursing, 48(2), 31–35. https://doi.org/10.3928/00989134-20220110-03
ŞİMŞİR, İ., & Altındiş, S. (2019). COULD VALUE-BASED PURCHASING APPROACH BE USED IN ASSESSMENT OF HEALTHCARE DELIVERY OUTPUTS? Konuralp Tıp Dergisi, 475–481. https://doi.org/10.18521/ktd.591897
Walters, J. D., Walsh, R. N., Smith, R. A., Brolin, T. J., Azar, F. M., & Throckmorton, T. W. (2019). Bundled Payment Plans Are Associated With Notable Cost Savings for Ambulatory Outpatient Total Shoulder Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons, 28(19), 795–801. https://doi.org/10.5435/jaaos-d-19-00441
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