Executive Summary

With melodramatic increment in healthcare costs, and advancing monitoring of quality of healthcare services, policymakers and experts are coming up with strategies to redesign the setting of the healthcare system. According to recent studies and initiatives, it is clear that they tend to play a significant role in this effort via value-based purchasing activities. In the same note, various attempts prove how purchasers can ensure and improve the quality of health programs. A reasonable explanation for that line of thinking is that customers are wielding and their considerable purchasing power can be deployed to enhance the quality of healthcare services. Value-based purchasing remains to be one of the remarkable strategies that employers can implement to improve the quality and value of healthcare services offered to their employees. This type of approach tends to ensure that health plans and providers are financially accountable for delivering high quality, competent patient care, and high-value care. In the discipline, if healthcare, the most used types of value based purchase strategies are value-based insurance system and value-based payment. Value-based payment is the current payment method used in healthcare to pay for services, and it remains aimed at rewarding value and not volume (fee-for-service). On the other hand, value-based insurance design is an insurance benefit design that encourages the notion of high-value clinical services usage by aligning clients spending’s with high quality and beneficial health medication and services.

The Aventura hospital and medical centre attempt to provide opportunities for people who are unable to access quality care from the diverse environment including various home healths and another type of healthcare systems depending on their value of the purchase. Therefore, the Aventura hospital and medical centre tend to figure the implementation of the cost-based purchase program as a critical step in titivating how Aventura hospital and medical centre pays for the healthcare services. In that regard, the facility tends to see how it will move towards rewarding the better value, patient-focused for patient care, and outcome instead of focusing on the volume of the services provides (fee-for-service). The Aventura hospital and medical centre value base program will develop a value-based incentives payment in fiscal years to their various departments and agencies that meet the performance criteria for the speculated period of the fiscal years. In reality, incentives are some of the factors that tend to achieve a good quality of work among employees. Apart from using the financial incentive to reward excellence and improvement in health care, the value-based purchase is aimed to ensure that it holds providers accountable for the provision of quality care. Thus, this ideology is vital to provide that high healthcare service is offered thus promoting more effective, efficient and quality acre process and addressing variations in quality care across various healthcare departments.

The creation and implementation of the value based purchase program will align with the various departments which include the intensive care unit, emergency department, and surgical services thus improving and efforts to move into another level in the coordination of care among these departments. The intensive care unit plan to develop this type of strategies to promote healthcare that is focused on the total need of the clients, families and the entire communities. Additionally, this type of approach is designed in a system that it helps doctors to interact with other providers thus dropping their administrative burdens effectively. Valued base purchase strategies are built on three main pillars that are affordable care, healthy individuals and community, and better care. Again, the design of the Aventura hospital and medical centre value base purchase program can be built upon the notion gained from the Medicare quality of their VBP inventiveness and State of isolated sector exertions to indorse groundbreaking payment and service conveyance. According to the current situation of the Aventura hospital and medical centre, value base purchase strategies tend to offer a sound indication and reasons why this kind of foundation is needed so that it can provide the philosophy of holding wage-earners responsible for the superiority of care they offer to their payees. In that regard, the implementation of this program will mark the shift of the current Aventura hospital and medical centre state to the next step on the continuing energies to tie payment to the achievements of the facility services. This strategy will also offer the facility with the opportunities for providing safe, timely, and effective’s service. Additionally, the Aventura hospital and medical centre value-based program is designed in a form that it is capable of supporting the future changes in needed data, payment systems, and reporting that will be encountered due to technological advancement ion healthcare systems.

 

INTRODUCTION

With a per capita expenditure of about $4, 670 in 2000, the United States tend to be among the country that is spending more than twice as much any other industrialised nation on health care on a per capita basis (Harris et al., 2017). Relaying on the current trends, the Centers for Medicare and Medicaid services predicated that healthcare expenses will reach $9,997 per person in 2021, reflecting 17.9 per cent of the GDP (Chee et al., 2016). Typically, how much individuals pay for healthcare services has nothing to do with the quality of care offered. For that reason, the implementation of the value base purchase strategies will help individuals to measure the quality of health care, and providers are paid centred on achieving it.

Additionally, the notion of implementing value based purchase program has some of the advantages on healthcare provision, some of the benefits of this programs include, an increased long-term financial sustainability of health benefits of the Aventura hospital and medical centre, increased productivity in various departments, attendance and employees satisfaction. Moreover, this program will also improve the health outcome of the Aventura hospital and medical centre. The ideology of switching to value-based purchasing reimbursement and value-based care framework tends to turn the traditional model of healthcare sectors reimbursement to its head by forcing the provider to alter the way they bill for care (Harris et al., 2017). Instead of focusing on the number of visits to predict their payment, providers no are paid according to the quality of service that they are offering. Therefore, this type of shifting is vital since it is driving improvement to the kind of service that is currently provided in the various health cares by mandating better care at lower costs.

According to section 3006(b) (1) of the Patient Protection and Affordable Care Act (Crockett, & Eliason, 2016), enacted on March 23, 2010, as amended by the Health Care and Education Reconciliation Act of 2010, adopted on March 30, 2010 (collectively known as the Affordable Care Act) necessitates the Secretary of Health and Human Services to cultivate a plan to implement a VBP program for payments under the Medicare program under Title XVIII of the Social Security Act for HHAs (Crockett, & Eliason, 2016). Conversely, section 3006(b)(2) of the Affordable Care call for the Secretary to deliberate some of the matters when mounting a plan to initiate a value based purchase platform for HHAs: the currently continuing expansion, reporting, edifice, procedures, and other determined problems (Crockett, & Eliason, 2016).

Current Aventura hospital and medical centre eminence, reporting, and reimbursement programs

The plan to initiate the Aventura hospital and medical centre value based purchase program will remain designed so that it allows coordination with the various existing department’s programs components to minimise the challenges and burden associated with the implementation of the program. Some of the vital elements of the value based purchase program are payment policies which are the prospective payment systems, quality and utilisation measures, and reporting systems. Under the current existing potential payment systems, Aventura hospital and medical centre pay HHAs on the nationally standardised 60-day rate that remained adjusted for wage index, case-mix, and other relevant factors. As long as this program tends to offer significant benefits to the facilities beneficiaries, the facility permits to participate in the program continuously is provided (Harris et al., 2017).

Currently, Aventura hospital and medical centre collect data on various measures that can be combined in the value based purchase program to replicate the HHA enactment. In the line of the reporting systems, the Outcome and Assessment Information Set (OASIS) tend to be the primary sources of data that is currently deployed in Aventura hospital and medical centre (Crockett, & Eliason, 2016). It has generated an agency that is specific quality reports since 2001. On the same note, the Agency for Healthcare Research and Quality (AHRQ) happened to develop the HHCAHPS to anticipate the first reporting of patients’ state and experience data (Harris et al., 2017).

Aventura hospital and medical centre goals for goals base purchasing program

Aventura hospital and medical centre tend to figure value base purchase program as a vital step to revamping how Medicare pays for healthcare services and goods that are offered thus moving the program in the direction of rewarding better outcomes, innovation, and better value instead of the volume of the services provided. In that regard, Aventura hospital and medical centre facility considered the following principles during the development of the program to align with the other value-based payment initiatives.

1)    One of the remarkable goals of this program is to ensure that communal description and the value based purchase payment systems bank on the mix of ethics, consequences, process, and persistent care experience.

2)    In the practical extent, measures deployed by the Aventura hospital and medical centre facility should be nationally endorsed in the line of the various stakeholders of the organisation. They should also be affiliated with the best practice among the other multiple financiers and the need of the end consumers of the processes.

3)     The intensive care, emergency, and the surgical services departments will work in liaison to ensure that the value based purchase is effectively implemented through continuous evaluation and recommendation for further improvement in the implementation process.

4)    The collection of the data in this field should ensure that it minimises the burden on the provider to the extent possible. In addition to that line of thinking, the providers should be rated according to their achievement in the range of national benchmarks. Considering that notion of reasoning, the VBP program turns to be a vitally important strategy in this ideology (Chee et al., 2016). The logic behind this line of thinking is that the VBP program methodologies offer a significant improvement in performance as an independent goal.

 

Value-based purchase strategies

In the face of considerable progress in the previous decades, the integrated state healthcare system still tends to face some quality of care challenge, which can be categorised to the incidence of overuse, misuse, and underuse. Various approaches have been developed toward improvement to quality care including the usage of the evidence-based purchase, professional development, the clinical and medical guideline. In that regard, some of the healthcare purchases both private and public are attempting to create the roadmap to building their quality considerations into their health care procuring program (Warren et al., 2016). For that matter, it is clear that customers obligate a keen interest in the deriving and quest of excellence when making healthcare purchase choices and decisions. Additionally, clients nowadays are starting to demand accountability from the service provider and measuring the worth they obtain for the health care dollar consumed. The following are the main strategies that the Aventura hospital and medical centre will deploy to implement this program regarding the intensive care, emergency and surgical services departments.

Quality information collection

The notion of data collection is the important, paramount phase in the value based purchase ingenuities. In this context, the purchase will have the responsibility of strengthening their activities so that they have reliable performance information on the service providers’ health plan. Therefore, every department will have an opportunity to lay down the purchases that they believe will help ensure quality care outcomes are attained with adequate reimbursement within the projected timeline.

Selective contracting with High-Quality providers

Even though only a few firms have a direct contract with the provider network, their potential role for quality care provision is substantial (Chee et al., 2016). This form of selection is conjoint in mutual purchasing approaches which centre upon a group of purchasers contracting selectively with strategies or provider societies based on established performance. For instance, the exemplary method of direct recruiting is the buyers’ health care action group which remains based in Minnesota’s Twin Cities. As for that reason, every department will have an opportunity to determine and conduct a selective contracting of personnel with the required quality and skills that will help the organisation improve it’s over patient care services.

Partnering with providers with an aim to Quality Improvement

Slightly than eliminating plans via selective contracting, buyers may improve health plan and providers performance by joining hands with continuous quality improvement efforts. In that point of view, the sole principle for the value-based program initiative is to providers accountable by measuring their performance (Chee et al., 2016). In addition to that point of view, there are various leaders coalition that has been developed by multiple healthcare organisation to ensure that there is a good education, communication, and coordination activities as a catalyst for community catalogue among all stakeholders in the Aventura hospital and medical centre. The three basic departments will thus have an opportunity to partner with providers directly for guidance and support on how to implement and improve the quality of their patient care services.

Six- Sigma promotion strategy

Six-sigma tool is a vital methodology that is playing a significant role to ensure that organisation achieves quality service provision. Therefore, the Aventura hospital and medical centre facility will attempt to embrace this tool to develop a specific technique that will meet the requirement of quality care in the facility. This ideology contains five main steps: which define, measures, control, improve, and analyse. The main driving force behind this line of thinking is that this model tends to reduce waste and thus to improve the quality and time demands of a procedure to reach an adequate level of perfection (Chee et al., 2016).

The degree the Aventura hospital and medical centre facility has embraced value based purchase

Funding the based purchase program

In contemporary society, various options play a significant role in linking payments to performance. One of the remarkable options is the continuous usage of the current existing payment systems in the Aventura hospital and medical centre facility fee for service where the income of the providers’ portion is annually updated to comply with the previous years. For that matter, is eligible for the payment update would be connected to a commentary of excellence events and recital on those dealings. An alternative possibility would be to enact reimbursement suppresses from HHAs comparable to the sanatorium VBP approach where the payment withholds, and recompense alteration that occurs during the same time or results in a net change.

The ideology of value based purchase program will play a critical role in the transition of the current payment system to the VBP system (Chee et al., 2016). In this line of thinking, accurate data and reporting system will be vital to evaluate the performance and initial phase of this program. During this transition period, the Aventura hospital and medical centre facility will calculate and report new value based purchase program composite measures to clarify and inform the HHAs of their various scores before settling for performance. For instance, this program will deploy multiple stages for the value based purchase program increment (Warren et al., 2016).

Stage 1: pre-implementation

During this stage, the Aventura hospital and medical centre facility will focus on the concept 0f incentive provision on the complete and accurate OASIS data delivery to reinforce the current payment system by ensuring that they place more emphasis on the episode level data. For instance, the fee-for-service reporting punishment could be created for those individuals who delay reporting by scaling two per cent. Besides that perspective, the Aventura hospital, and medical centre facility will create a direct measure of the agency’s performance in the line of reporting rate of the OASIS, assessment, DRDT, and ROC. Finally, during this stage, the Aventura hospital and medical centre facility could also introduce the public reporting mechanisms which also include the utilisation, patients’ safety, and electronic health technology.

Stage 2: the introduction of the Funding mechanism

The second important implementation stage is the introduction of the funding mechanism. In that point of view, this program will consider the continuous adjustment of the current funding mechanism. Alternatively, this program will examine the ideology of adopting the subsidy contrivance in which a proportion of all episodes amount received would be pending from assistances to endowment the program.

Stage 3: Rewarding both performance and reporting

This stage is a very crucial part of this program since it serves as a hybrid between the current payments systems with the new value based purchase system.  The Aventura hospital and medical centre facility could regulate part of an intervention’s yearly apprise or return a proportion of the payment suppress to agencies based on their facts commentary rate while tying pay to enactment for the outstanding quantity (Warren et al., 2016).

Stage 4: based reward entirely on performance

The next part of the enactment stage will completely stalemate Value Based Purchase program expenditures to production, and the pay-for-reporting program could remain wholly obsolete. Thus, this knowledge will help evaluate the HHA commentary occurrence that will distress VBP payments to the degree that the absent statistics would subordinate activities’ complex notches and the succeeding VBP outgoings (Parkinson et al., 2015). Therefore, due to that matter, this stage remains to be one of the essential steps during the implementation plan of value based purchase program.

Stage 5: evaluate the program and incorporate lesson learned

The concluding phase of the execution plan is the evaluation of the program to figure out if the program has achieved its goals and objectives.  This will focus on the aspect of the value-based program by considering the various evaluation concept gained in class. For instance, there will be multiple evaluation programs like impact evaluation, outcome evaluation, and process evaluation. Regarding the notion of the facility performance, this will call for the expansion of the value based purchase program measures to reproduce the vicissitudes in both countrywide urgencies and experimental ideas (Warren et al., 2016).

A strategic plan to continue progressing Value Based Purchase program in the Aventura hospital and medical centre facility

By developing the viable strategic plan that stimulates the progress of the value based purchase approaches in the Aventura hospital and medical centre facility, the performance of the facility need to remain assessed (Parkinson et al., 2015). Besides that point of view, there is a need for the employees to understand the position that their organisation stands and their previous information. This notion will help the organisation to effectively and efficiently implement the value based purchase program in their various department daily operations thus focusing on the value.

Secondly, the Aventura hospital and medical centre facility will develop programs that are meant to educate the workforce, management, medical practitioners, and physicians in their efforts to ensure there is an improvement for quality of the service that they provide. To add on, the interoperability between the three departments in the facility will play a significant role to ensure that there are active communication channels and coordination thus reducing costs while improving the posting of the quality services that the facility is offering to their beneficiaries.

Thirdly, the facility will develop a strategic approach to effectively collect then right data and sound information for making healthy decisions. This kind of data is vital for the organisation since it will help the top management to decide on the implementation plan process.  To add on, the facility will embrace the enterprise warehouse data infrastructure to ensure that there is reliable and accurate data to accommodate their financial and clinical data.

Further, the facility will select some of the clinicians from the three central departments to epitomise data and identify any arising challenges and address them immediately. Finally, the facility will develop various current costs and structures to lower them without sacrificing the quality of services provided.

Critical department in the facility

The three significant departments that will play a significant role in the implementation of the value based purchase program are the intensive care unit, emergency department, and surgical services. The primary function and part of the three departments as far as the implementation of the value based purchase program is that they form the fundamental foundation for the effective and efficient implementation of the cost based purchase strategies in health care organisations (Parkinson et al., 2015). Therefore, the workers in these departments should be well prepared about the implementation of the VBP within their respective departments.

The Aventura hospital and medical centre facility stakeholders' duties and responsibility

The primary stakeholders in the Aventura hospital and medical centre facility are the patients, physician, insurance companies, employers, government, and pharmaceutical firms (Crockett, & Eliason, 2016). The insurance companies play the role of selling health care coverage plans directly to the patients or indirectly. Pharmaceutical firms are one of the significant stakeholders for the Aventura hospital and medical centre facility to develop and market medication that is prescribed by the physician to the patients. In that perspective, it is clear that the relationship between healthcare and stakeholders is somewhat complicated. But the critical part is the primary responsibility for these stakeholders is to hold and maximise stockholders wealth (Parkinson et al., 2015). The stakeholders will, therefore, ensure every department is ready and well organised for the projected implementation of the VBP with successful health care outcomes within a timeline of three years.

Ethical incorporated into the strategic plan

Building clinical, moral consideration via planning strategies remains to be one of the most critical elements of ethics management. Therefore, the approach tends to create a foundation for how the facility will carry out its operations (Crockett, & Eliason, 2016). The philosophy of building ethics into strategic planning is essential to ensure that every facet of the organisation is aligned with the ethos and values of the broader organisation. For that matter, the facility will deploy four mechanisms to ensure that ethical considerations are incorporated into the program. The first element of strategic planning mechanism is via the development of the code of ethics among the stakeholders of the facility.

This activity will allow the facility to grow organically over time as the facility dream to increase in the future (Crockett, & Eliason, 2016). The next strategy is the deployment of ethical training among the employees in the facility. Investing in the practice of employees on the norms and principles of behaviours create a critical foundation for ensuring that moral consideration is achieved in the facility. Additionally, training also equips employees and with skills that are required to deal with various complex issues in the workplace (McBain et al., 2016). The third stage is the deployment of the ethics officer’s advice on how to deal with multiple ethical problems as they arise. It is also important to deploy ethic officers since this will help the situations to improve the organisation’s ethical strategy (Harris et al., 2017). Finally, the adoption of confidential reporting systems is the last approach that can be deployed to incorporate moral consideration in the facility. In reality, not all ethical situations are easy to handle there; the facility will develop an infrastructure to deal with these technical challenges that may arise without anyone on the spot.

Communication plan

Currently, the facility is planning to deploy face to face meeting as the channel of communication (Kondo et al., 2016). This method will allow health care consumers to be aware of the opportunities the ACO provides for care coordination via printed brochures and the fact sheets. Additionally, the organisation is planning to deploy community forums which are expected to be held quarterly.

Financial Projection planning

For the Aventura hospital and medical centre facility to possibly project their savings, there is the need for an organisation to understand the size of their target population so that they can manage the average Total Costs of Care (TCC). It’s a standard roadmap when starting such as exertion, and there was some of the specifical data for this population. Consequently, multiple data points should be used to provide estimates of the current costs of NC’s population. Some approaches to remedy this deficiency include the ideology of getting actual prices and member months of the community from historical data (Crockett, & Eliason, 2016). Secondly, it’s the notion of getting historical and current facility membership numbers including the statewide and by county. Finally, the data should assume the proportions of health facility membership which should remain constant by zip code and county.

The proforma:

The proforma remained created using the most recent ACO expense budget for the linkage of the revenue to the value based purchase model. In the following description, the manager can postulate various budgeting scenarios by merely adjusting the parameters so that they can arrive at their intended final situations.

 

 

 

References

Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016). The current state of value-based purchasing programs. Circulation, 133(22), 2197-2205.

Crockett, D., & Eliason, B. (2016). What is data mining in healthcare? Insights: Health Catalyst.

Harris, C., Allen, K., Waller, C., & Brooke, V. (2017). Sustainability in Health care by Allocating Resources Effectively (SHARE) 3: Examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting. BMC health services research, 17(1), 340.

Kondo, K. K., Damberg, C. L., Mendelson, A., Motu’apuaka, M., Freeman, M., O’Neil, M., … & Kansagara, D. (2016). Implementation processes and pay for performance in healthcare: a systematic review. Journal of general internal medicine, 31(1), 61-69.

McBain, R. K., Jerome, G., Warsh, J., Browning, M., Mistry, B., Faure, P. A. I., … & Leandre, F. (2016). Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing. BMJ global health, 1(3), e000134.

Parkinson, B., Sermet, C., Clement, F., Crausaz, S., Godman, B., Garner, S., … & Elshaug, A. G. (2015). Disinvestment and value-based purchasing strategies for pharmaceuticals: an international review. Pharmacoeconomics, 33(9), 905-924.

Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence‐Based Nursing, 13(1), 15-24.