**7. Information technology**

All over the world the interest in VBHC is growing. With this growing interest and rapid acceptance of both patient and providers, it is important to have the right tools to record and analyze patient's data toward a value-based model. That is why the implementation of a value-enhancing information technology system, such as a patient electronic data record, is so important.

It is critical for the implementation of value-based healthcare to be successful such as the use of electronic data record. The completion of data and reduction of the potential loss of data, by not keeping patient paper records, are critical for the correct measurement of outcomes [23].

Some electronic records today are very good for keeping data but make it hard to export those records for later analysis. There are six elements that are key for a value-enhancing IT platform for the IPUs [15].

First, the platform must be centered on the patient. The system needs to follow the patients across the services and through time for the full cycle of care. Data are aggregated around the patients not locations. So, all parts of the team have access to the same and complete records, instead of the physicians having access only to his notes or other physicians' notes, he is capable of accessing the records from the nurse staff, physical therapists, and so on [15].

Second, it needs to use common data definitions. The data fields related to diagnose, medical history, and other aspects of care are standard according to the condition being treated so everyone can understand what it means and it is easy to export when needed across the entire system [15].

Third, it encompasses all types of patient data. Notes, images, laboratory tests, and many other are stored in the same place and in a standard format. Like said before, everybody has access to everybody's notes and to the complete patient record. Access is not limited to the IPU team leader [15].

Fourth, the access is available to all parties involved in care. That means that the data collected have to be available to the patients and any referring physicians. The best information technology system possible is the one in that the patients can schedule appointments, refill their prescription, and communicate with their physicians and to the rest of the IPU team, in a simple and easy way. It also should

be made easy to access some types of information needed for the evaluation of the care given to the patient [15].

Fifth, every medical condition should have its own template. This set of templates makes it easy and efficient for the IPU teams to retrieve the data they need in order to execute procedures and measure the patient's outcomes and risk factors and the costs of the full cycle of treatment [15].

And finally, the system must be easy to extract information. In a value-enhancing system, the data to measure outcomes, track costs, and control the patient risk factors must be easy to extract. They should also allow the patient to report on his/ her own outcomes, so that clinicians can make better decisions [15].

The Cleveland Clinic is a good example of an institution that followed all those steps when adopting a value-enhancing data system [24].

#### **8. Reimbursement**

The reimbursement changes in a value-based model. Instead of fee-for-service like in a volume-based model, the reimbursement occurs after the full cycle of care. It is essential to have this payment reform. Physicians paid in a fee-for-service tend to provide more care compared with salaried physicians [25]. Also, the fee-forservice payment method is not necessarily aligned with value to the patient.

Payment per activities encourages more procedure done, maintains fragmentation, and discourages prevention, which does not stimulate high-quality care to the patient [26]. According to the authors, high-value care should limit per capita cost, improve patient experience, and improve population health [27].

Emphasis of VBHC is developing and implementing a bundled-payment known as pay-for-performance (P4P). This payment method focuses on aspects of value that can be measured using indicators of quality [27]. Cattel and Eijkenaar in their 2019 article give a comprehensive view on a new payment initiative that combines two elements: 1—global base payments and 2—explicit quality incentives [27].

The rationale of their initiative is that in essence, the global payment is a bundled payment, with the bundle being constructed at a higher level than at the level of conditions or treatments. The second component, the quality incentives, is sort of a P4P payment that rewards measurable aspects of value [27].

Some aspects of value cannot be explicitly measured such as well-coordinated care or many health outcomes are difficult or impossible to measure. While important, they cannot be explicitly accounted for in the payment contract [28]. Designing the base payment as a global payment facilitates cost-consciousness and well-coordinated care across the full cycle of care, with a focus on the patient instead of on separate conditions [27].

Global base payment transfers the risk from payer to provider which may cause a few problems such as diminishing quality or attempting to underprovide expensive services. These concerns have been addressed by Frakt and Meyers [29], and they can be addressed by risk-sharing arrangements in global payment and explicit quality incentives.

The components of the global base payment are, to a multidisciplinary provider group, for a cohesive set of care activities to a predefined population, fixed for a defined period of time, risk-adjusted, and with risk-mitigating measures. The components of the explicit quality incentives need to have a method of linking payment to quality, with quality measures and with quality incentive structure [26].

This payment initiative described above is a little different than that proposed by Dr. Porter. In his initial model, reimbursement would be done after the complete cycle of care and would include all services and medications, and treating inpatients

**185**

*Value-Based Healthcare*

health-care model.

**9. Comparison**

will get paid.

their work load.

**11. Conclusion**

platform [30].

**10. Limitations and obstacles**

is too risky with no real assurances.

who are more likely not to get better.

through with the necessary steps to make it work.

*DOI: http://dx.doi.org/10.5772/intechopen.93378*

system to benefit from value improvement [9].

and outpatient's services together. This model would reward true value and incentivate innovation among physicians [3]. Bundled reimbursement allows for all the

Today, reimbursement takes place for discrete services not for the entire cycle of care. This works against value, according to Dr. Porter [9]. Value is created by the entire care cycle, not the parts. A change in the payment method is required for the VBHC to work. In essence independently of what reimbursement model you use, for value-based healthcare to work, reform is needed. A fee-for-service model, which is the prevailing way of reimbursement today, does not work in a value-based

The fee-for-service is the prevailing model of healthcare in the US and around the world. The patient pays for a medical service, such as visits, tests, and surgical procedures. In theory, the physician charges to cover their costs and for a profit, the patient knows through itemized bills what they are paying for and they can compare

The value-based health-care model has a pay-for-performance reimbursement system. In primary care, for example, the patient pays a monthly, quarterly, or annual retainer fee. This fixed price is regardless how many visits or test the patient requires. As long as the patient is satisfied to continue this plan, physicians

The limitations of the value-based health-care model are that it must be led by physicians and that can pose as a problem. If physicians sense that this new model can limit their gains with reimbursement, they may be inclined not to follow

Physicians are also worried they have little to no time with the IPU team, lack of transparency with the providers, and find it hard to meet quality expectations. Some physicians are not implementing a value-based healthcare because they fear it

Other physicians say that this model is beyond the scope of their practices. Should an internist be concerned about organizing someone's efforts to quit smoking? And so, this only adds on to the physicians' responsibilities and with

Another problem raised is that some fear that tying the physician salaries directly to outcomes might encourage them to refuse to treat the sickest patients

There is a strategic agenda for creating value-based health-care system. It should encompass what we have seen so far in this chapter: organize into IPUs, measure outcome and costs for every patient, move to value-based reimbursement models and bundled payments, integrate and coordinate care in multi-site care delivery systems, expand across geography, and build an enabling information technology

the prices with other providers. This competition will drive prices down.

#### *Value-Based Healthcare DOI: http://dx.doi.org/10.5772/intechopen.93378*

and outpatient's services together. This model would reward true value and incentivate innovation among physicians [3]. Bundled reimbursement allows for all the system to benefit from value improvement [9].

Today, reimbursement takes place for discrete services not for the entire cycle of care. This works against value, according to Dr. Porter [9]. Value is created by the entire care cycle, not the parts. A change in the payment method is required for the VBHC to work. In essence independently of what reimbursement model you use, for value-based healthcare to work, reform is needed. A fee-for-service model, which is the prevailing way of reimbursement today, does not work in a value-based health-care model.

## **9. Comparison**

The fee-for-service is the prevailing model of healthcare in the US and around the world. The patient pays for a medical service, such as visits, tests, and surgical procedures. In theory, the physician charges to cover their costs and for a profit, the patient knows through itemized bills what they are paying for and they can compare the prices with other providers. This competition will drive prices down.

The value-based health-care model has a pay-for-performance reimbursement system. In primary care, for example, the patient pays a monthly, quarterly, or annual retainer fee. This fixed price is regardless how many visits or test the patient requires. As long as the patient is satisfied to continue this plan, physicians will get paid.
