One of the most notable shifts in healthcare is more active participation by the general public. Despite this shift and the advent of healthcare reform, measurement and transparency of outcomes that matters to all of us remains limited. Stakeholders are able to come together at the HIMSS Innovation Center to address the potential of the Value Equation. The importance of a more consistent set of standard metrics for major and chronic medical conditions is elevated to include well-defined methods for collection and risk adjustment.

The Value Equation

There is little disagreement that the U.S. healthcare economy is unsustainable. To address this situation, unparalleled public and private reform is underway to usher in a new economy that rewards quality, efficiency and collaboration. The continued reform effort is shifting focus from the volume of services delivered to the value created for patients. Value has been defined differently by several organizations. HIMSS has host of resources that provide both a structure and vocabulary with which your organization can organize its value strategies, including the HIMSS Value Suite, the HIMSS Value Score and Pathways to Value.

Hospital Value-Based Purchasing (VBP), Hospital Acquired Conditions (HAC) and Hospital Readmissions Reduction Program (HRRP) are part of the Centers for Medicare & Medicaid Services’ (CMS’) long-standing effort to link Medicare’s payment system to a value-based system to improve healthcare quality, including the quality of care provided in the inpatient hospital setting. All three of the programs are part of the recent public reform underway that attaches value-based metrics to reimbursement. The metrics that comprise these programs account for the largest share of Medicare spending, affecting payment for inpatient stays in more than 3,500 hospitals across the country.

The most recent research from the Agency for Healthcare Research and Quality indicates that approximately 1.2 million fewer patients were harmed between 2010 – 2013, which resulted in 50,000 fewer patient deaths and approximately $12 billion in costs saving. The data also indicate that there is still progress to be made, and HACs continue to be a significant source of morbidity in addition to healthcare costs.

The continued emphasis on value-based reimbursement by the nation’s largest payer has sponsored action by states and the private sector to create innovative payment models. Embracing the idea that today’s payment methods most certainly will be different going forward and understanding the potential opportunities and threats associated with the shift to value-based reimbursement remain crucial business issues for every provider across the country.

Meeting Value Head On

Informed patients with a consumer-driven mindset, armed with accessible, digestible data on value, should benefit from higher quality, lower cost care for themselves and their families. HIMSS has developed a series in person videos on the value of health IT. This growing self-awareness around value by all stakeholders will continue placing increased purchaser pressure on the players across healthcare to advance more collaborative and consistent delivery approaches. More prepared providers will use innovative payment models, margin retention/enhancement opportunities, and other distinctive care-related tools and techniques to translate value across the delivery system. Solving the Value Equation and meeting evolved patient needs will require all of this and more to further advance the movement toward a common set of quality metrics with transparent cost information that effectively and accurately present a comprehensive profile.

^{Perspectives in Healthcare in a joint publication developed by the tenants of the Global Center for Health Innovation in Cleveland, OH.}