Understanding Value Based Care Management

In a concurrent session held at 5:00 p.m. yesterday, Stefani Daniels, RN, MSNA, CMAC, ACM, discussed how case management has evolved through the years and they ways in which the marketplace has influenced program models. She also explored the differing ways patients, providers and payers define value and presented a roadmap to implementing a value-based model of care management.

She opened by stating that healthcare costs are unsustainable, noting many countries with higher life expectancies than the U.S. spent much less on healthcare. She quoted Gov. Mike Leavitt of Utah: "There’s not a place on the economic leaderboard for a country that spends 20 to 25% of its GDP on healthcare."

She said that value is always defined around the stakeholders, and it depends on results, not inputs. She added that value-based care ties payment to quality, not quantity of care, with the goal of incentivizing better care and lower costs.

She said that if incentives are changed, then case management strategies and care coordination must change as well.

She laid out the following four "essential pieces to the roadmap to value-based care management":

1.Universal vision

2.Restructure for patient-centered care

3.Organize by adopting population health concepts

4.Translate value into improved outcomes