Abstract
To address escalating healthcare costs in the USA, many are advocating incorporating a value-based system for healthcare delivery including bundled payments for services. However, this approach brings unintended consequences that could potentially cause new disparities in access and services. Existing health status, or pre-existing conditions, appears to constrain patient access to important, but expensive, treatments, based on measures of quality and inclusion criteria for treatment. While on the surface these decisions appear scientifically sound, the practical solutions available to the obese, diabetic or elderly with multiple chronic comorbidities or socio-economic barriers and limitations who attempt to achieve better health are limited. There may be no single solution, but a serious dialog about ensuring the shift by CMS to a new “value-based payment” model must recognize and address potential unintended consequences. We suggest a new definition of value which includes access as a key component to compensate for this inherent problem.
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Notes
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Medicare Access and CHIP Reauthorization Act of 2015.
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Merit-based Incentive Payment System.
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For example the VA ones can be found at http://www.healthquality.va.gov/guidelines/
References
Betbeze, P. (2016). Get comfortable with bundles. www.health leadersmedia.com. Accessed 040416.
Bozic, K. (2017). Value-based healthcare: A novel transitional care service strives to improve patient experience and outcomes. Clinical Orthopaedics and Related Research., 475(11), 2638–2642. https://link.springer.com/article/10.1007/s11999-017-5481-8.
Bracy, C. (2016). The healthcare value creation equation. http://www.aaos.org/AAOSNow/2016/Apr/Managing/managing5/. Accessed Apr 1 2016.
Bumpass, D., & Samora, J. (2016). Price transparency in health care: The other half of the value equation. http://www.aaos.org/AAOSNow/2015/Jan/advocay/advocay1/?ssopc=1. Accessed Apr 11 2016.
Chang, B., Bakken, S., Brown, S., Houston, T., Kreps, G., Kukafka, R., Sfran, C., & Stavri, Z. (2004). Bridging the digital divide: Reaching vulnerable populations. White Paper JAMIA, 11, 448–457.
Economists View (2005). Cherry picking profitable operations from general service hospitals.
Haddad, P., Schaffer, J. L., & Wickramasinghe, N. (2015). Evaluating Business Value of IT in Healthcare: Three Clinical Practices from Australia and the US. In MEDINFO 2015 August 19–23 Sao Paulo, Brazil: EHealth-enabled Health: Proceedings of the 15th World Congress on Health and Biomedical Informatics (Vol. 216, p. 183). IOS Press. 19–23 August 2015.
Hero, J., Blendon, R., Zaslavsky, A., & Campbell, A. (2016). Understanding what makes Americans Dissatisfied with their health care system: An international comparison. Health Affairs, 35(3), 502–509.
Hsu, J., Huang, J., Kinsman, J., Fireman, B., Miller, R., Selby, J., & Ortiz, E. (2005). Use of e-health services between 1999 and 2002 a growing digital divide. JAMIA, 12, 164–171.
Kaplan, R., & Porter, E. (2011). How to solve the cost crisis in health care. Harvard Business Review, 89(9), 46–52. Reprint R1109B.
Lynn, J. (2016). Value based care hurting most vulnerable hospitals. http://www.hospitalemrandehr.com/2016/03/25/value-based-carehurting-most-vulnerable-hospitals/
Moghimi, H., de Steiger, R., Schaffer, J., & Wickramasinghe, N. (2013). The benefits of adopting e performance management techniques. Health & Technology, 3(3), 237–247. ISSN: 2190–7188.
Pearlstein, S. Free Market Philosophy doesn’t always work for health care. Washington Post, June 8 2005.
Porter, M. (2010). What is value in health care? The New England Journal of Medicine, 363(26), 2477–2481.
Porter, M., & Lee, T. (2013). The strategy that will fix health care. Harvard Business Review, 91, 50–70. Reprint R1310B.
Porter, M., & Teisberg, E. (2009). Redefining health care. Boston: Harvard Business Review Press.
Sarkar, U., Karter, A., Liu, J., Adler, E., Nguyen, R., Lopez, A., & Schilling, D. J. (2011). Social disparities in internet patient portal use in diabetes: Evidence that the digital divide extends beyond access. Journal of the American Medical Informatics Association, 18, 318–321.
Weeks, W., Rauh, S., Wadsworth, E., & Weinstein, H. (2013). The unintended consequences of bundled payments. Annals of Internal Medicine, 158, 62–64.
Yamin, C., Emani, S., Williams, D., Lipsitz, S., Karson, A., Wald, J., & Bates, D. (2001). The digital divide in adoption and use of a personal health record. Archives of Internal Medicine, 171(6 Mar 28), 568–574.
Zuvekas, S., & Cohen, J. (2016). Fee-for-service, while much maligned, remains the dominant payment method for physician visits. Health Affairs, 35(3), 411–414.
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Wickramasinghe, N., Silvers, J.B., Sloane, E.B., McCoy, M.J., Schaffer, J.L. (2020). Data, Denial, and Disparity: Is This a New Digital Divide?. In: Wickramasinghe, N., Bodendorf, F. (eds) Delivering Superior Health and Wellness Management with IoT and Analytics. Healthcare Delivery in the Information Age. Springer, Cham. https://doi.org/10.1007/978-3-030-17347-0_20
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