background
Healthcare systems face a tremendous challenge to provide patient care and insurance as the healthcare marketplace transitions to value-based reimbursement. In order to compete financially and optimize the quality of patient care provided, institutions must adjust to the new reality of value-centric care.
PRO & Td-abc
Measuring value in healthcare requires the measurement of both outcome and cost. PROs (patient reported outcomes) have become the gold standard in medicine, providing both a voice for patients and validated quantification of function. With the collaborative efforts of the REDCap system and CODE Technology, nearly all surgical orthopaedic interventions are now collecting PROs. Cost has been evaluated in numerous ways, however the cost of care delivery has been most accurately measured using TD-ABC (time-driven activity-based-costing). Our team has developed a model that leverages the timestamp function of the Epic EMR to efficiently collect cost of care using TD-ABC over the entire episode of care including all aspects of care from labs to physical therapy visits.
plva
These two measures, PROs and TD-ABC, combine to give a single number or value score. We call this methodology patient level value analysis (PLVA). The power of this system is to provide actionable data on the value of care provided down to the individual patient level for a given procedure. Measuring the value of care for each individual patient allows us to determine which aspects of a care pathway positively and negatively affect the value of care provided. This data can then be aggregated to create the average value delivered by each provider, which we call provider level value analysis (pLVA).
future direction
Our goal is to apply this framework across the ten most common orthopaedic procedures across healthcare systems. The implementation of this model will allow patient, injury, and institutional characteristics that affect the value of care provided to be modified to maximize the care administered. Data can then be aggregated to identify which providers deliver the highest value care (best outcomes for the lowest cost).
The application of PLVA to the orthopaedic service line will position both the care delivery and insurance branch at the forefront of healthcare. Poised with the power of this platform, the stage is set to align physician and health system agendas to drive physician behavior and incentivize performance.