Policies focused designed to drive value-based payment & delivery pose major implications -- intended and otherwise -- for health systems and stakeholders. We review, unpack, and glean insights from such policies.
Our team has worked with decision makers to analyze or provide input on policies aimed at improving quality and addressing avoidable spending. Examples of this work:
Improvement requires evaluation of programs & initiatives. We utilize rigorous methods to evaluate programs and their impact on clinical, quality, and cost outcomes.
VSSL members have led large-scale evaluations of quality- and value-based payment and delivery programs, and their impact on patients. Examples of this work:
Program: Bundled payments (prominent payment model for improving the value of care)
Evaluations: Over the last 5 years, VSSL Director Dr. Joshua Liao and colleagues have been at the forefront of using advanced statistical methods to evaluate the impact of nationwide bundled payment programs.
As a part of this portfolio of work, Dr. Liao and colleagues recently used advanced econometric methods to evaluate the long-term association between hospital participation in joint replacement bundles and quality, and cost outcomes. Main findings included:
* 1.6% differential decrease in average episode spending
* These savings were driven by early, not late, participants
* No differential changes in quality outcomes
In a separate study, Dr. Liao and colleagues evaluated how hospital co-participation in (i.e., simultaneous participation in both) joint replacement bundles and accountable care organizations impacted outcomes. They found that compared to hospitals bundling joint replacement only, those co-participating in joint bundles and accountable care organizations had differential changes in 90-day unplanned readmissions and post-discharge care utilization patterns.
From Liao JM, et al. Association of Bundled Payments for Joint Replacement Surgery and Patient Outcomes With Simultaneous Hospital Participation in Accountable Care Organizations. JAMA Network Open. 2019.
Strategic approaches are needed to effectively implement programs that improve the quality, cost-efficiency, and value of care. We advance frameworks and principles that support these efforts.
Our team members are leaders in advancing frameworks and principles that can help stakeholders understand how to strategically implement solutions that improve quality or address spending. Examples of this work:
Care Standardization & Variation Reduction
Implementation Issue(s): Though care standardization is thought of as way to reduce unwarranted variation and improve care, its success depends on how it is implemented.
Work: Drs. Leah Marcotte, Christopher Chen, and Joshua Liao created a framework for how health care organizations can strategically implement and manage clinical pathways as care standardization initiatives.
From Chen CP, Marcotte LM, Herner K, Liao JM. Value-Based Management of Clinical Pathways: An Applied Framework. Journal of Clinical Pathways. 2019.
Pathways In Population-based Payment Models
Implementation Issue(s): Clinical pathways are often conceived as solutions for episode-based payment models. Though they can also be potentially used in population-based models, little is known about how to design and implement such pathways.
Work: Drs. Leah Marcotte and Joshua Liao defined principles that can be used to design and effectively implement primary care-oriented pathways within population-based payment models such as accountable care organizations. For instance, they identified several principles related to unique features of such pathways:
* cadence of care delivery
* timeline for expected benefits
* breadth of clinical focus
Implementation Issue(s): There are multiple forms of care management, each with different emphases. Successful care management involves a framework for distinguishing between these forms and executing one the desire one(s).
Work: Drs. Leah Marcotte and Joshua Liao outlined a framework that can be used by stakeholders to define and implement care management activities to increase the benefit to patients.
From Marcotte LM, Liao JM. What We Talk About When We Talk About Care Management. Am J Manag Care. 2020.