Value-Based Purchasing Is On Target, But Is It A Value To Older Adults And Their Families?

The 2016 election has had and will continue to feature a robust discussion on the Affordable Care Act and its future. Meanwhile, the Obama administration continues to implement the 2010 law. Flurries of regulations and guidelines have been issued over the past six years and will continue until the end of the administration.

One of the more important and potentially enduring new rules was first issued in 2012 when Medicare began rewarding hospitals based on high-quality care, not volume of services, through the Hospital Value-Based Purchasing (VBP) Program. In January 2015, the Centers for Medicare and Medicaid Services (CMS) made a landmark announcement to accelerate the timeline for transitioning Medicare from fee for service payments to value-based reimbursement, setting a goal of 30 percent of all Medicare payments to be tied to these alternative payment models by the end of 2016. Earlier this year, CMS announced it had already met this goal months ahead of schedule.

As we accelerate the shift to value-based care, one important question we must pause to ask is how older adults, families, caregivers and care providers are keeping pace? Do consumers know how to engage and navigate in this new quality and value landscape? Are there gaps we still need to address and if so, how?

Person-centered care is at the core of the patient experience. The American Geriatrics Society released a national consensus definition for person-centered care last December, articulating eight essential elements, from creating a goal-oriented plan of care based on personal preferences to performance measurement based on feedback from the person and their family. The SCAN Foundation has also developed a business case resource and return on investment calculator to help increase adoption of person-centered care models. This adoption can potentially increase an older adult's value of their experience.

First, to include older adults as partners in conversations about healthcare value, they need to have an appreciation of what drives healthcare costs. But, a recent Xerox survey suggested that less than 5 percent of older adults were even considered "very savvy" consumers on knowing about cost and how to shop around for healthcare.

We need to close this information gap. Are we working to develop tools on healthcare costs, resource utilization and value as part of health literacy education programs for older adults? Older adults can and should play an important role in the use of high-value, low-cost services as well as in limiting use of low-value, high-cost services. For example, disease-associated malnutrition can lead to poor health outcomes, yet is often not recognized by individuals or their clinicians. Malnutrition screening, assessment, diagnosis and treatment are relatively low-cost interventions that can decrease healthcare resource utilization and costs. Educating older adults, their families and caregivers on this issue and on how to engage in a person-centered plan of care could bring down healthcare costs significantly in this population. The DefeatMalnutrition.Today coalition also recommends that CMS adopt malnutrition care quality measures in value-based programs to help improve outcomes that are important to patients and clinicians.

Another area to consider is how value-based care is prioritized and measured. For example, in the Hospital Value-Based Purchasing Program Patient and Caregiver-Centered Experience of Care, it is currently measured through patient surveys of health care staff communication, responsiveness and assessment of patient preferences. Research in the area of these person-centered measures is still developing; investigations are pending on how demographic and structural factors may predict patient scores, as well as how to improve quality surveys by including the views of family caregivers and presenting a complete view of the full healthcare experience. The National Health Council is also collaborating with the National Quality Forum and the University of Maryland to create a patient-specific curriculum on health care quality to help educate patients about their essential role in the creation of health care quality measures. This work is being conducted through a grant awarded by The Patient-Centered Outcomes Research Institute (PCORI).

A recent Rand Corporation report has raised an intriguing question about how one measures a successful value-based purchasing program. In light of that, one can connect the need to have Medicare beneficiaries, their families, caregivers and care providers fully engaged and knowledgeable early enough to factor into measuring success. Reforms of this magnitude are important, but to be enduring must benefit not only the health care systems but also its consumers, especially older adults.