The Complexity of Defining Value-Based Health: Perspectives from Patients

Health care organizations (HCO), including hospitals, physician offices, and urgent care clinics have adopted approaches and delivery models of care to align with payment models. HCO are shifting from a fee for service to a value-based payment model. In this model, algorithms are used to promote quality care and decrease cost. Value-based is a term used for a care model, patient approach, and a payment model. But how do patients perceive value-based care on their health?

Nurses are in a unique position, as they are present in all settings to bridge the gap in health disparities by understanding payment models and ensuring the patients values and preferences are communicated during the patient encounter.

Background: Factors that impact health disparities in urban and rural communities include race and ethnicity, economics, social, geographic, and health workforce issues. How have health disparities been impacted by the implementation of value-based payment models? Delivery of care has been approached by payment sources and types as opposed to patient needs. Understanding patient and provider perspectives can help to shift the focus of delivery of care to what is appropriate for patients.

Objective: Using focus group methodology, we aimed to explain patients’ experiences while obtaining health care services and their values and needs.

Methodology: Three focus groups were selected based on racial and ethnic groups and geographic communities or service areas. The first group were African-American urban patients, who received care from an university hospital/health system or private clinic. The second group were Hispanic urban patients, who obtained care from a community or private clinic. The final group were rural providers and patients of mixed ethnicity.

Results: Each focus group consisted of 8-12 female participants aged 40 years or above. Discussing patients’ experiences, the subthemes included lack of communication, money motivated health care, biased care, and lack of availability of timely care. They also expressed health care as a “numbers game” where cost, insurance coverage, and average number of patients per physician per day are the driving factors for treatment decisions.

Conclusion: This study concluded the gap in implementation of value-based health care delivery. Ensuring the focus of care based on valued attributes can address health disparities.

References:
1. Agency for Clinical Innovation. NRC+Pickers description of positive aspects of the health care experience. https://www.aci.health.nsw.gov...
2. Delaney, L. (2018). Patient- centered care as an approach to improving health care in Australia. Collegian, 25(1), 119-123.
3. AHRQ. Strategy 6.I shared decision-making. https://www.ahrq.gov/cahps/quality-improvement/improvementguide/6- strategies-for-improving/communication/strategy6i- shared-decisionmaking.html