Current Issue: Volume 15, Issue 2: Value in Brain Injury Healthcare
Content currently available in print only
Value Based Payment: Implications and Challenges for Medical Rehabilitation
Gary Ulicny, PhD
Principles-to-Practice: Payment Opportunities for Healthcare Providers
Adam Seidner, MD, MPH, CIC
Patient-Centered Care: A Focus on Optimal Recovery
John Watts Jr.
Neuro-Net and the Seamless Future for Brain and Spinal Cord Injury Rehabilitation
Ann Perkins, MA, Debra Braunling-McMorrow, PhD, Deborah Doherty, MD, Ben Dirlikov, MA, Irwin Altman, PhD, MBA
Message from the Guest Editor
Michael Choo, MD
U.S healthcare spending reached $3.49 trillion in 2017 and is forecasted to grow another 5.2% in 2018. As healthcare policy debate rages on in Washington, D.C., about how to best rein in and control this unsustainable growth, reality is starting to set in: The prevailing fee-for-service reimbursement may be transitory.
Particularly in the rehabilitation industry, there is growing need to justify the necessity of interventions by demonstrating the benefits to payers. This is especially challenging for post-acute providers because rehabilitation benefits tend not to be realized immediately, but incrementally over the care continuum. So, how do providers best demonstrate to payers the Return-on-Investment (ROI) or value of rehabilitation services?
To start, many of us in healthcare use the terms ROI and value interchangeably to articulate the merits of medical services, but it is important to acknowledge that payers define them distinctly. ROI is a purely financial metric calculating profits or additional revenues acquired from an investment. On the other hand, value is defined as the relative benefit or worth achieved with a given cost or spend, meaning the gains in healthcare are cost avoidance or improved quality outcomes or — even better – both. This makes the concept of value-based care and value-based reimbursement much more relevant and appropriate for healthcare than ROI.
Although the principles of value seem simple and clear, the way forward is arduous because “value” lends itself to many variations and permutations depending upon the stakeholder. Three questions, to begin with: Which variables should be considered in the “quality outcome” numerator? Which carerelated utilizations should be incorporated? And how should the temporal elements be factored into the equation?
Dr. Gary Ulicny’s thought-provoking article fundamentally supports the benefits of transitioning to a value-based approach, and he challenges healthcare providers, payers, and policymakers to take action. His article strongly urges rehabilitation providers to consider standardizing clinical outcome measures that are functionally meaningful to patients and family, rather than average Length of Stay. He further emphasizes the providers’ responsibility to promote the level of evidence-based and evidence-informed clinical interventions, while validating the cost effectiveness associated with current and future rehabilitation care approaches. Dr. Ulicny proposes that payers adopt innovative value-based payment incentives to align the providers’ focus on outcomes. His hopes for policymakers are to simplify regulations to be more pragmatic and to encourage provider innovation. Dr. Adam Seidner from The Hartford Financial Services Group, Inc. gives a comprehensive review of the strengths and weaknesses of healthcare payment models from the traditional to the more novel. Dr. Seidner guides providers in preparing for various types of reimbursement models; defining and measuring successful outcomes, and finally in how to engage payers to mutual benefit. The article by John Watts, Jr., CEO of Paradigm Outcomes, provides his perspective gleaned from
many years leading large commercial group health payer organizations and other healthcare-related companies. Mr. Watts extols the merits of value-based care and urges healthcare stakeholders to adopt a systematic and integrated expert continuum of care, delivering the right interventions at the right time, providing improved quality of life for injured workers, and increasing value for long-term medical costs. His article offers fundamentals and key attributes of value-based care organizations, such as a culture of accountability and outcomes, and data-utilization methods that drive ultimate value – great outcomes at a lower cost.
Sharing the success of Neuro-Net, an integrated network of providers within the post-acute care continuum, Ann Perkins et al, demonstrate how collaboration provides value-based care by improving
outcomes and reducing costs for patients with brain and spinal cord injuries. The authors of the article demonstrate that utilizing experts in the care continuum can indeed improve efficiency, effectiveness, and lead to better clinical outcomes.
Lastly, Dr. Marc Duerdin offers very insightful perspectives to my interview questions regarding value and rehabilitation needs with Brain Injury conditions. His expertise and wisdom gleaned from his years of clinical practice in rehabilitation as well as his administrative roles in the development and adjudication of payment policies for Medicare and other commercial payers offer a “point of view” for clinical providers to consider going forward.
So, enjoy this special summer edition of Brain Injury Professional.
About the Guest Editors:
Michael Choo, MD is Paradigm Outcomes’ Chief Medical Officer. He maintains relationships with Paradigm’s network of consulting physicians and centers of excellence, and is responsible for enhancing clinical operations and leading research and development. He also teaches emergency medicine, internal medicine, and family practice residents at Wright State University’s Boonshoft School of Medicine.
Dr. Choo has an MBA and is an oral board examiner for the American Board of Emergency Medicine, a fellow of the American College of Emergency Physicians, and a fellow and board member of the American Academy of Emergency Medicine.
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