School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy.
Hepatology. 2017 May;65(5):1749-1755. doi: 10.1002/hep.29042.
The migration from legacy fee-for-service reimbursement to payments linked to high-value health care is accelerating in the United States because of new legislation and redesign of payments from the Centers for Medicare and Medicaid Services. Because patients with chronic diseases account for substantial use of health care resources, payers and health systems are focusing on maximizing the value of care for these patients. Because chronic liver diseases impose a major health burden worldwide affecting the health and lives of many individuals and families as well as substantial costs for individuals and payers, hepatologists must understand how they can improve their practices. Hepatologists practice a high-intensity cognitive subspecialty, using complex and costly procedures and medications. High-value patient care requires multidisciplinary coordination, labor-intensive support for critically ill patients, and effective chronic disease management. Under current fee-for-service reimbursement, patient values, medical success, and financial success can all be misaligned. Many current attempts to link health outcomes to reimbursement are based on compliance with process measures, with less emphasis on outcomes that matter most to patients, thus slowing transformation to higher-value team-based care. Outcome measures that reflect the entire cycle of care are needed to assist both clinicians and administrators in improving the quality and value of care. A comprehensive set of outcome measures for liver diseases is not currently available. Numerous researchers now are attempting to fill this gap by devising and testing outcome indicators and patient-reported outcomes for the major liver conditions. These indicators will provide tools to implement a value-based approach for patients with chronic liver diseases to compare results and value of care between referral centers, to perform health technology assessment, and to guide decision-making processes for health authorities. This review sets the groundwork for implementing a value-based, patient-centered approach to chronic liver diseases within a health system. (Hepatology 2017;65:1749-1755).
从传统的按服务收费的报销模式向与高价值医疗保健相关的支付方式转变在美国正在加速，这是由于新的立法和医疗保险和医疗补助服务中心支付方式的重新设计。由于慢性病患者大量使用医疗资源，支付方和医疗系统正在专注于为这些患者最大化护理的价值。由于慢性肝脏疾病在全球范围内造成了重大的健康负担，影响了许多个人和家庭的健康和生活，也给个人和支付方带来了巨大的成本，因此肝病学家必须了解如何改进他们的实践。肝病学家从事高强度认知亚专科，使用复杂和昂贵的程序和药物。高价值的患者护理需要多学科协调、对重症患者的劳动密集型支持以及有效的慢性病管理。在现行的按服务收费的报销制度下，患者的价值、医疗的成功和财务的成功都可能不一致。目前许多将健康结果与报销联系起来的尝试都是基于对过程措施的遵守，而对患者最重要的结果的重视较少，从而减缓了向高价值团队护理的转变。需要反映整个护理周期的结果衡量标准来帮助临床医生和管理人员提高护理的质量和价值。目前还没有一套全面的肝脏疾病结果衡量标准。现在许多研究人员正在通过设计和测试主要肝脏疾病的结果指标和患者报告结果来试图填补这一空白。这些指标将为慢性肝脏疾病患者提供实施基于价值的方法的工具，以便在转诊中心之间比较护理结果和价值，进行卫生技术评估，并为卫生当局提供决策过程指导。这篇综述为在卫生系统内实施基于价值、以患者为中心的慢性肝脏疾病方法奠定了基础。（《肝脏病学》2017 年；65 卷：1749-1755）。
