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Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System

Value-based reimbursement strategies have been considered in the continuous search for establishing a sustainable healthcare system. For models that have been already implemented, success is demonstrated according to specific details of the patients’ consumption profile based on their clinical condi...

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Autores principales: de Silva Etges, Ana Paula Beck, Liu, Harry H., Jones, Porter, Polanczyk, Carisi A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Columbia Data Analytics, LLC 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621730/
https://www.ncbi.nlm.nih.gov/pubmed/37928822
http://dx.doi.org/10.36469/001c.89151
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author de Silva Etges, Ana Paula Beck
Liu, Harry H.
Jones, Porter
Polanczyk, Carisi A.
author_facet de Silva Etges, Ana Paula Beck
Liu, Harry H.
Jones, Porter
Polanczyk, Carisi A.
author_sort de Silva Etges, Ana Paula Beck
collection PubMed
description Value-based reimbursement strategies have been considered in the continuous search for establishing a sustainable healthcare system. For models that have been already implemented, success is demonstrated according to specific details of the patients’ consumption profile based on their clinical condition and the risk balance among all the stakeholders. From fee-for-service to value-based bundled payment strategies, the manner in which accurate patient-level cost and outcome information are used varies, resulting in different risk agreements between stakeholders. A thorough understanding of value-based reimbursement agreements that views such agreements as a mechanism for risk management is critical to the task of ensuring that the healthcare system generates social impacts while ensuring financial sustainability. This perspective article focuses on a critical analysis of the impact of value-based reimbursement strategies on the healthcare system from a social and financial perspective. A critical analysis of the literature about value-based reimbursement was used to identify how these strategies impact healthcare systems. The literature analysis was followed by the conceptual description of value-based reimbursement agreements as mechanisms for achieving social and financial impacts on the healthcare system. There is no single successful path toward payment reform. Payment reform is used as a strategy to re-engineer the way in which the system is organized to provide care to patients, and its successful implementation leads to cultural, social, and financial changes. Stakeholders have reached consensus regarding the claim that the use of value reimbursement strategies and business models could increase efficiency and generate social impact by reducing healthcare inequity and improving population health. However, the successful implementation of such new strategies involves financial and social risks that require better management by all the stakeholders. The use of cutting-edge technologies are essential advances to manage these risks and must be paired with strong leadership focusing on the directive to improve population health and, consequently, value. Payment reform is used as a mechanism to re-engineer how the system is organized to deliver care to patients, and its successful implementation is expected to result in social and financial modifications to the healthcare system.
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spelling pubmed-106217302023-11-03 Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System de Silva Etges, Ana Paula Beck Liu, Harry H. Jones, Porter Polanczyk, Carisi A. J Health Econ Outcomes Res Perspective Value-based reimbursement strategies have been considered in the continuous search for establishing a sustainable healthcare system. For models that have been already implemented, success is demonstrated according to specific details of the patients’ consumption profile based on their clinical condition and the risk balance among all the stakeholders. From fee-for-service to value-based bundled payment strategies, the manner in which accurate patient-level cost and outcome information are used varies, resulting in different risk agreements between stakeholders. A thorough understanding of value-based reimbursement agreements that views such agreements as a mechanism for risk management is critical to the task of ensuring that the healthcare system generates social impacts while ensuring financial sustainability. This perspective article focuses on a critical analysis of the impact of value-based reimbursement strategies on the healthcare system from a social and financial perspective. A critical analysis of the literature about value-based reimbursement was used to identify how these strategies impact healthcare systems. The literature analysis was followed by the conceptual description of value-based reimbursement agreements as mechanisms for achieving social and financial impacts on the healthcare system. There is no single successful path toward payment reform. Payment reform is used as a strategy to re-engineer the way in which the system is organized to provide care to patients, and its successful implementation leads to cultural, social, and financial changes. Stakeholders have reached consensus regarding the claim that the use of value reimbursement strategies and business models could increase efficiency and generate social impact by reducing healthcare inequity and improving population health. However, the successful implementation of such new strategies involves financial and social risks that require better management by all the stakeholders. The use of cutting-edge technologies are essential advances to manage these risks and must be paired with strong leadership focusing on the directive to improve population health and, consequently, value. Payment reform is used as a mechanism to re-engineer how the system is organized to deliver care to patients, and its successful implementation is expected to result in social and financial modifications to the healthcare system. Columbia Data Analytics, LLC 2023-10-31 /pmc/articles/PMC10621730/ /pubmed/37928822 http://dx.doi.org/10.36469/001c.89151 Text en https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (4.0) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Perspective
de Silva Etges, Ana Paula Beck
Liu, Harry H.
Jones, Porter
Polanczyk, Carisi A.
Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System
title Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System
title_full Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System
title_fullStr Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System
title_full_unstemmed Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System
title_short Value-based Reimbursement as a Mechanism to Achieve Social and Financial Impact in the Healthcare System
title_sort value-based reimbursement as a mechanism to achieve social and financial impact in the healthcare system
topic Perspective
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621730/
https://www.ncbi.nlm.nih.gov/pubmed/37928822
http://dx.doi.org/10.36469/001c.89151
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