Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
J Arthroplasty. 2018 Jun;33(6):1636-1640. doi: 10.1016/j.arth.2018.01.028. Epub 2018 Feb 10.
Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force.
To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models. The changes that occurred at our institution are described.
Real-time data and knowledgeable personnel working behind the scenes, while physicians provide clinical care, help move clinical pathway redesigns. Engaged physicians are essential to the successful implementation of value creation and care pathway redesign that can lead to improvements in value. An investment of money and resources toward added infrastructure and personnel is often needed to realize large-scale improvements. Alignment of providers, payers, and hospital administration, including by means of gainsharing programs, can lead to improvements.
Although significant care pathway redesign efforts may realize substantial initial cost savings, savings may be asymptotic in nature, which calls into question the likely sustainability of programs that incentivize or penalize payments based on historical targets.
与其他医疗服务模式相比，在大学附属医院的医疗体系中创造价值具有独特的挑战。在此，我们介绍了在犹他大学开展的联合关节置换护理服务中创造价值的经验，该大学已将基于价值的医疗改革理念作为其核心和推动力。
为了提高价值，需要重新设计护理、医师领导以及参与替代支付模式等方面的新资源。本文描述了我院发生的变化。
实时数据和幕后的专业人员，与提供临床护理的医生一起，有助于推动临床路径的重新设计。积极参与的医生对于成功实施价值创造和护理路径重新设计至关重要，这可以带来价值的提升。通常需要投入资金和资源来改善基础设施和人员配备，以实现大规模的改进。通过收益分享计划等方式，使提供者、付款人和医院管理部门达成一致，可以带来改善。
尽管大量的护理路径重新设计工作可能会带来显著的初始成本节约，但节约可能会呈现出渐近的性质，这使得基于历史目标激励或惩罚支付的计划的可持续性受到质疑。
