While the American Society of Anesthesiologists (ASA) recently focused on value-based care in their Annual Perioperative Surgical Home Summit, now they are bringing the concept to their larger annual meeting at this year’s ANESTHESIOLOGY conference in Chicago in October.
According to the ASA, this year’s conference theme, Leading the Future of Health Care, “embraces the changing dynamics of medicine and will introduce [participants] to the concept of value-based competition.” That concept, largely attributed to the keynote speaker of the conference, Dr. Michael E. Porter, Bishop William Lawrence University Professor at the Harvard Business School, maintains that only providers who improve patient outcomes and maintain or improve their efficiency while doing so can be competitive in today’s healthcare climate.
“In this environment, providers need a strategy that transcends traditional cost reduction and responds to new payment models,” write Porter and co-author Thomas H. Lee, MD, in a 2013Harvard Business Review article, “The Strategy That Will Fix Health Care.”
“If providers can improve patient outcomes, they can sustain or grow their market share. If they can improve the efficiency of providing excellent care, they will enter any contracting discussion from a position of strength. Those providers that increase value will be the most competitive. Organizations that fail to improve value, no matter how prestigious and powerful they seem today, are likely to encounter growing pressure. Similarly, health insurers that are slow to embrace and support the value agenda—by failing, for example, to favor high-value providers—will lose subscribers to those that do.”
In this climate, value-based healthcare, then, is measured primarily in terms of the value to patients and secondly by improved value to payers or the overall economy.
“We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need,” Porter and Lee write. “We must shift the focus from the volume and profitability of services provided—physician visits, hospitalizations, procedures, and tests—to the patient outcomes achieved. And we must replace today’s fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health-delivery organizations and in the right locations to deliver high-value care.”
For anesthesiologists, the approach being offered and encouraged by the ASA is the Perioperative Surgical Home (PSH), in which the patient’s experience of care is coordinated by a Director of Perioperative Services, additional Surgical Home Leadership, and supportive personnel which constitute an interdisciplinary team. That team is organized around the patient and his needs and serves as, what Porter and Lee call, an integrated practice unit (IPU), which is the core concept behind their value-based care-delivery model.
As an IPU, perioperative surgical homes are created around conditions, such as the Centers for Medicare and Medicaid Services’ Comprehensive Joint Replacement program, and help a patient through established treatments and any related conditions, complications, and circumstances. Through the episode of care, IPUs engage patients and their families through education and counseling, treatment adherence and prevention protocols, and any other necessary behavioral changes such as smoking cessation or weight loss. According to the PSH website, success is measured through “improved operational efficiencies, decreased resource utilization, a reduction in length of stay and readmission, and a decrease in complications and mortality-resulting in a better patient experience of care.”
The ASA has created the PSH Learning Collaborative 2.0, which began April 1, 2016, to continue with the success of their first learning collaborative, and to create conversation, education, and initiatives around PSH strategies that are compatible with alternative payment models such as the Bundled Payments for Care Improvement (BPCI), Comprehensive Care for Joint Replacement (CJR), the Medicare Shared Savings Program (MSSP), and Accountable Care Organizations (ACOs). The collaborative welcomes new participants who are at the earliest stages of PSH participation and those seeking more advanced guidance.
As well, attendees of the annual ANESTHESIOLOGY conference can participate in several sessions geared toward value-based care and perioperative medicine, including “The Seven Steps for Setting Up a Perioperative Surgical Home,” presented by Zeev Kain, M.D., M.B.A.. Anesthesiology, University of California, Irvine.
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