From patient care to value-based payments: we’re learning

Debbie Peikes, Ph.D., MPA



Dr. Peikes is a nationally recognized health- services researcher with decades of experience leading rigorous mixed- methods studies of innovative payment and care delivery models. She has an extensive record of publications and presentations sharing insights about refining and spreading effective models.

As the healthcare industry continues to shift away from quantity of care toward quality of care, recent research helps illustrate the value of value-based care. Those studies show how physicians use the approach to drive better patient outcomes.

Deferred care

As pandemic social distancing widened to include medical distancing—significantly reducing office visits for routine and sick care early in 2020—healthcare leaders used a broad range of communications and operational tactics to ensure patients received proper care amid a COVID-19 surge, according to a report by the Medical Group Management Association (MGMA) and Humana.

The publication, “No Time to Waste: Deferred Care and Pandemic Recovery,” found that during the COVID-19 pandemic, 97% of practices polled reported a drop in patient visits by early April 2020.11 A lack of reliable internet connection for patients in rural areas, older patients not being as tech savvy when attempting telehealth services and vulnerable populations having trouble connecting to platforms such as Zoom, FaceTime and Hangouts all posed challenges to accessing care in 2020.

Continuing to engage patients in their health, ensuring they are willing to seek and receive care as needed, face-to-face or via a computer screen, is vital for medical practice growth in the year ahead, researchers said.

Evaluation of home health

Inpatients (IP) eligible for the post-acute transfer program who received additional services in their homes after a hospital discharge experienced lower risks of readmission and decreased healthcare costs.

Humana Health Research (HHR) researchers evaluated the effectiveness of discharge to home health compared to home for patients discharged from an inpatient stay for a set of diagnostic related groups (DRGs) that met the criteria for post-acute transfer as defined by the Centers for Medicare & Medicaid Services.

MA members affiliated with value-based physicians and receiving home health services had a 60% lower risk of readmission to a hospital within 30 days of discharge and a 45% lower readmission risk within 60 days, compared to those members with non-value-based physicians. Additionally, care of those members resulted in an 11% lower total 90-day healthcare cost, including costs associated with home healthcare.1

Changing patient patterns

Value-based payment, particularly when downside financial risk is involved, may be associated with reduced use of the emergency department (ED) and greater use of primary care, according to a study by HHR.

Researchers assessed the association of primary care physician payment arrangements with PCP visits, emergency department visits, inpatient admissions and avoidable IP admissions in a cohort of newly eligible MA enrollees over a 30-month period.

At the end of that period, the average annualized PCP visit rate was significantly greater—3,408 visits per 1,000 members vs. 2,712 per 1,000—for the group of members affiliated with value-based care physicians compared to the group affiliated with non-value-based physicians.1

The 30-month average annualized ED visit rate was lower for members whose PCPs were in value-based payment arrangements—194 visits per 1,000 members—compared to those whose physicians were in non-value-based arrangements—209 visits per 1,000 members.1