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Value-based program not associated with clinical process improvement, study finds

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Dive Brief:

  • A new report in The New England Journal of Medicine found that Hospital Value-Based Purchasing (HVBP) program did not improve measures in clinical process or patient experience and was not associated with “significant reductions” in two of three mortality measures.

  • Study authors evaluated whether quality improved more in acute care hospitals exposed to HVBP in comparison to control hospitals.

  • The study measured quality by “composite measures of clinical process and patient experience and 30-day risk-standardized mortality among patients who were admitted to the hospital for acute myocardial infarction, heart failure or pneumonia.”

Dive Insight:

The researchers found clinical process and patient experience “were not significantly greater” for hospitals with HVBP. The program was also not associated with a reduction of mortality among patients admitted for acute myocardial infarction or heart failure, but there was a “significant reduction in mortality” for patients admitted with pneumonia.

The findings are similar to other studies on value-based care. Though value-based care is seen as a a way to rein in rising health costs and improve patient outcomes, recent studies have shown that it hasn’t consistently improved outcomes and costs.

Holly Martin, senior manager at Top Tier Consulting, recently told Healthcare Dive, “Part of the challenge is people are changing and innovating and seeing results in quality and cost, and Medicare is seeing some reduced payments, but the accumulated learning experience is hard to consolidate nationally… CMS is pleased with the trend and the progress, but the actual dollar amounts that are being saved are not huge compared to the healthcare spend overall.”

Value-based care has its influential supporters like Kaiser Permanente, which co-signed a letter with other healthcare leaders in April calling for a move to a value-based healthcare system that puts the patient at the center of care and focuses on outcomes. Also, CMS has already converted 30% of its fee-for-service payment to a value-based model with a goal of 50% by 2018.

There is momentum for the idea of value-based care, but without consistent study results showing improved outcomes and lower costs, don’t expect hospitals and health systems to sign up gladly.

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