Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY; The Rogosin Institute, NY, NY.
Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Population Health, Mass General Brigham, Boston, MA.
Adv Chronic Kidney Dis. 2022 Jan;29(1):30-39. doi: 10.1053/j.ackd.2021.10.001.
The United States health care system has increasingly embraced value-based programs that reward improved outcomes and lower costs. Health care value, defined as quality per unit cost, was a major goal of the 2010 Patient Protection and Affordable Care Act amid high and rising US health care expenditures. Many early value-based programs were specifically designed for patients with end-stage renal disease (ESRD) and targeted toward dialysis facilities, including the ESRD Prospective Payment System, ESRD Quality Incentive Program, and ESRD Seamless Care Organizations. While a great deal of attention has been paid to these ESRD-focused programs, other value-based programs targeted toward hospitals and health systems may also affect the quality and costs of care for a broader population of patients with kidney disease. Value-based care for kidney disease is increasingly relevant in light of the Advancing American Kidney Health initiative, which introduces new value-based payment models: the mandatory ESRD Treatment Choices Model in 2021 and voluntary Kidney Care Choices Model in 2022. In this review article, we summarize the emergence and impact of value-based programs on the quality and costs of kidney care, with a focus on federal programs. Key opportunities in value-based kidney care include shifting the focus toward chronic kidney disease, enhancing population health management capabilities, improving quality measurement, and leveraging programs to advance health equity.
美国的医疗保健系统越来越多地采用基于价值的项目，这些项目奖励改善的结果和降低的成本。医疗保健价值，定义为单位成本的质量，是 2010 年《患者保护与平价医疗法案》的主要目标，因为美国的医疗保健支出居高不下且不断上升。许多早期的基于价值的项目是专门为终末期肾病 (ESRD) 患者设计的，针对透析设施，包括 ESRD 前瞻性支付系统、ESRD 质量激励计划和 ESRD 无缝护理组织。虽然人们对这些针对 ESRD 的项目给予了极大的关注，但其他针对医院和医疗系统的基于价值的项目也可能影响更广泛的肾病患者的护理质量和成本。鉴于“推进美国肾脏健康倡议”，基于价值的肾脏疾病护理越来越重要，该倡议引入了新的基于价值的支付模式：2021 年强制性 ESRD 治疗选择模型和 2022 年自愿性肾脏护理选择模型。在这篇综述文章中，我们总结了基于价值的项目对肾脏护理质量和成本的出现和影响，重点是联邦项目。基于价值的肾脏护理的主要机会包括将重点转向慢性肾脏病，增强人群健康管理能力，改善质量衡量标准，并利用项目促进健康公平。
