Value-Based Purchasing and Shared Risk Models

Introduction

As a health care leader, you will need to continually analyze the role the organization plays in futuristic models of value-based purchasing and shared risks. These models are constantly changing, so an astute health care leader develops an organizational culture that is agile, innovative, and responsive to be best positioned for the future. The key is to ensure the alignment of the organization’s structure with strategic initiatives driving customer-focused results.

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Scenario

Health care organizations are increasingly expected to link provider payments to improved performance. This model aims to hold providers accountable for the quality of care they provide in a cost-effective environment.

For the organization you have been analyzing throughout this course, identify critical components of a value-based purchasing model. Analyze budgetary and financial implications of value-based purchasing on health care management practices and decisions.

Then, identify examples of shared risk models, such as population health. Analyze budgetary and financial implications of shared risk models on health care management practices and decisions.

Begin analyzing evidenced-based strategies to develop an effective organizational culture, using relevant data and measures such as benchmarks, research, and best practices. Such evidenced-based strategies should help position the organization for the future, particularly given an environment of value-based purchasing and shared risk models.

Your Role

You are a senior leader of a health care organization, and you are in the midst of your complete analysis of the organization. At this point you have reviewed the strategic initiatives, the organizational structure, and barriers to access, quality services, and cost effectiveness. The next step of the analysis is to consider the organization’s role in value-based purchasing and shared risk models.

From your readings and research, you are learning that hospital value-based purchasing is an incentive program first introduced by CMS but now adopted by many managed care organizations. Value-based purchasing ties various quality care clinical best practices to hospital financial incentives. In addition, value-based purchasing ties in a patient’s reported subjective experience during their hospital stay. Hospitals are no longer being paid based on the quantity of services provided; rather there is now an emphasis on the quality of those services. These quality determinants are somewhat based on benchmarks set by hospitals in general, as well as year-over-year improvements within the same hospital setting. So there is a great deal at stake for hospitals to collect and use data to ensure optimal quality care and experiences are achieved. Now more than ever, such data plays a vital role in all decision making.

As a natural progression in the vision to improve access to care, provide quality care, and decrease cost, shared risk models are being field tested. Models, such as population health, focus on the role health care organizations play to ensure the overall wellness of communities. Such models require providers at all levels of health care, not just physicians and hospitals, to be accountable for wellness and prevention services; timely and accurate diagnostics; and cost effective, quality, and available treatment regimes. This model will require the creation of strategic partnerships among the various types of health care organizations to improve overall community health through innovative means. It ties significant financial incentives to encourage such strategic partnerships through a shared risk. Pharmaceutical companies, medical device firms, diagnostic services, managed care organizations, hospitals, physician practices, supply chain networks, et cetera all have a role in making community wellness possible. Sometimes this reaches outside the more traditional health care sector to include the likes of housing providers, weight loss clinics, and workout facilities. All such services are necessary in order to enhance the wellness of the community.

Though most of the literature applies value-based purchasing or incentives and shared risk to hospital settings, the truth is all health care organizations need to support these endeavors in order to remain competitive in this new world of health care delivery. As a senior leader of any health care organization, it is vitally important that you understand your role in this process to best position your organization as a strategic partner. This will allow you to maximize your organization’s success in this new era of health care.

Requirements

Create a report that includes the following:

Identify critical components of a value-based purchasing model.
Analyze budgetary and financial implications of value-based purchasing on health care management practices and decisions.
Identify examples of shared risk models, such as population health.
Analyze budgetary and financial implications of shared risk models on health care management practices and decisions.
Analyze evidenced-based strategies to develop an effective organizational culture, using relevant data and measures such as benchmarks, research, and best practices. Such evidenced-based strategies should help position the organization for the future, particularly given an environment of value-based purchasing and shared risk models.
Deliverable Format
Report requirements:
Ensure written communication is free of errors that detract from the overall message and quality.
Use at least two scholarly resources beyond those provided in this course, cited in APA format.
Your report should be 2–3 content pages, in addition to a title page and references page.
Use 12 point, Times New Roman.
Related company standards:

Use a professional report format of your choice. Remember that you are preparing a professional document meant for executive leadership with limited time. Your report should follow the corresponding MBA Academic and Professional Document Guidelines (available in the MBA Program Resources), including single-spaced paragraphs. If you are new to this type of writing and document style, you may wish to use these sections as a way to organize your report:

Title page.
Components of value-based purchasing models.
Implications of value-based purchasing on management practices and decisions.
Shared risk models.
Implications of shared risk models on management practices and decisions.
Strategies to develop effective organizational culture.
References.
Evaluation

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies through corresponding scoring guide criteria.

Competency 3: Analyze the role the organization plays in future models of value-based purchasing.
Identify multiple critical components of a value-based purchasing model.
Analyze budgetary and financial implications of value-based purchasing on health care management practices and decisions.
Competency 4: Analyze the role the organization plays in future models of shared risk.
Identify and analyze examples of shared risk models, such as population health.
Analyze budgetary and financial implications of shared risk models on health care management practices and decisions.
Competency 5: Recommend evidence-based strategies to develop an organizational culture in a health care setting that is agile, innovative, and responsive.
Analyze evidenced-based strategies to develop an effective organizational culture, using relevant data and measures such as benchmarks, research, and best practice.
Competency 6: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration.
Communicate organization background and analysis to company leadership in a report.

Faculty will use the scoring guide to review your deliverable from the perspective of the health care organization’s leadership. Review the scoring guide prior to developing and submitting your assessment.

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