FEATURE
TABLE 1
NATIONAL QUALITY STRATEGY GOALS ARE TO:
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Make care safer by reducing harm caused while care is delivered.
» » Improve support for a culture of safety.
» » Reduce inappropriate and unnecessary care.
» » Prevent or minimize harm in all settings.
» » Help patients and their families be involved as partners in their care.
» » Promote effective communication and coordination of care.
» » Promote effective prevention and treatment of chronic disease.
» » Work with communities to help people live healthily.
» » Make care affordable.
(https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/CMS-Quality-Strategy.
html)
TABLE 2
TYPES OF VALUE-BASED BENEFITS WITH ASSOCIATED EXAMPLES
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Individual Health Competency--incentives most often through cash equivalent or premium differential
» » Health Risk Assessment
» » Biometric testing
» » Wellness programs
Condition Management--incentives most often through co-pay/coinsurance differential or cash equivalent
» » Adherence to evidence based guidelines
» » Adherence to chronic medications
» » Participation in a disease management program
Provider Guidance--most often incentivized through co-payment or coinsurance differential
» » Utilization of a retail clinic versus an emergency room
» » Care through a center of excellence
» » Tier one high quality physician
(National Business Coalition on Health--Value Based Purchasing Guide: http://www.nationalalliancehealth.org/Value-Based-
Benefit-Design-Introduction)
SEPTEMBER 2017
11