D026 – Quality Outcomes in Value-Based Nursing Care

D026 – Quality Outcomes in Value-Based Nursing Care

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Western Governors University

D026 Quality Outcomes in a Culture of Value-Based Nursing Care

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What is Value-Based Care?

Value-Based Care (VBC) is a transformative healthcare approach focusing on improving patient health outcomes while controlling costs. It prioritizes the value derived from healthcare services by placing the patient at the core of care decisions, rather than the volume of services provided. This paradigm shift aims to enhance the quality and effectiveness of care, aligning clinical practices with patient-centered goals.

Elements of a Value-Based Healthcare Framework

The successful implementation of value-based care hinges on several critical elements:

These foundational components enable healthcare systems to deliver coordinated, effective, and patient-focused care.

Benefits of Value-Based Care for Patients and Populations

Value-based care provides tangible advantages for both individuals and the broader population, including:

1. Cost Efficiency: Patients experience lower out-of-pocket expenses while receiving better health outcomes.

2. Higher Patient Satisfaction: Improved communication and care coordination enhance the patient experience.

3. Enhanced Care Coordination: Care teams work more collaboratively to ensure seamless patient management.

4. Reduced Healthcare Costs: By focusing on quality, overall system costs decline.

5. Risk Reduction for Payers: Payers benefit from stronger cost control mechanisms and fewer unnecessary interventions (Capminds, 2020).

These benefits illustrate how value-based care aligns financial incentives with health improvements.

Why Implement Value-Based Care in Healthcare Organizations?

Healthcare organizations adopt value-based care for several compelling reasons:

• Value is generated when patients achieve meaningful health improvements.

• It aligns healthcare delivery with patients’ experiences and preferences.

• Clinicians reconnect with their core purpose as healers.

• It reduces unnecessary healthcare spending and reliance on continuous interventions.

• Population health improves as individual health outcomes advance (Teisberg, Wallace, & O’Hara, 2020).

This approach fosters a more sustainable, patient-centered healthcare system.

Role of the Advanced Professional Nurse in Value-Based Care

Advanced professional nurses play a pivotal role in driving value-based care by integrating the following practices:

These competencies enable nurses to lead value-based initiatives that enhance patient outcomes.

Value-Based Healthcare: Evidence from Peer-Reviewed Literature

Several key studies and articles provide insights into various aspects of value-based care:

Article 1: “What’s at Stake in U.S. Health Reform: A Guide to the Affordable Care Act and Value-Based Care” (Rambur, 2017)

• The Patient Protection and Affordable Care Act (ACA), known as Obamacare, introduced reforms supporting value-based care.

• Political and societal factors heavily influence healthcare policy evolution.

• Nurses play a crucial role in patient advocacy within the value-based framework.

Article 2: “Crossing the Health IT Chasm” (Adler-Milstein et al., 2017)

• Current health IT infrastructures often fall short in supporting value-based care needs.

• Delivering better care at lower cost requires improved access to clinical data and simplified documentation.

• Policy recommendations aim to close this gap and enable efficient value-based models.

Article 3: “Choosing Wisely in Oncology” (Rocque et al., 2017)

• The Choosing Wisely campaign educates clinicians and patients about cost-effective oncology care.

• Efforts led by the American Society of Clinical Oncology focus on aligning treatments with efficacy and cost.

• Results reveal trends such as increased use of imaging for certain cancers, highlighting ongoing challenges.

Article 4: “Clinical Pathways” (Abrahams et al., 2017)

• Clinical pathways support value-based care by maximizing evidence-based treatments and minimizing ineffective care.

• Transparency, patient engagement, shared decision-making, and accountability are essential.

• Pathways are regularly updated to reflect the latest evidence.

Article 5: “Value-Based Care in Hepatology” (Strazzabosco, Allen, & Tiesberg, 2017)

• Liver disease management illustrates challenges in delivering value-based care globally.

• Outcome measurement focusing on structure, process, and patient health effects can improve population health.

• A systematic approach to care delivery is vital for rare or severe diseases.

Strategies for Implementing Value-Based Care

Two key strategies are essential for successful implementation:

These strategies promote continuous learning and outcome-focused care delivery.

Assessing an Organization’s Readiness for Value-Based Care

Implementing value-based care requires evaluating several organizational domains:

Two identified organizational strengths include:

• Strong provider support: Providers are key stakeholders, and their adherence is crucial.

• Long-term commitment to quality: Continuous data collection and goal setting support sustained improvement.

Areas for improvement focus on:

• Upgrading IT resources to reduce documentation burden and improve data access.

• Enhancing staffing ratios to boost efficiency, prevent burnout, and optimize resource use.

Overall, the organization’s readiness involves proactive education, data-driven monitoring, and leadership engagement to support the transition toward value-based care.

References

Abrahams, E., Balch, A., Goldsmith, P., Kean, M., Miller, A., Omenn, G., Sonet, E., Sprandio, J., Tyne, C., & Westrich, K. (2017, August 15). Clinical pathways: Recommendations for putting patients at the center of value-based care. Clinical Cancer Research, 23(16), 4545-4549. https://clincancerres.aacrjournals.org/content/23/16/4545.full

Adler-Milstein, J., Embi, P., Middleton, B., Sarkar, I., & Smith, J. (2017, September). Crossing the health IT chasm: Considerations and policy recommendations to overcome current challenges and enable value-based care. Journal of the American Medical Informatics Association, 24(5), 1036-1043. https://doi.org/10.1093/jamia/ocx017

Capminds. (2020, October 14). 5 effective benefits of value based healthcare. https://www.capminds.com/blog/5-effective-benefits-of-value-based-healthcare/

Rambur, B. (2017). What’s at stake in U.S. health reform: A guide to the Affordable Care Act and value-based care. Policy, Politics & Nursing Practice, 18(2), 61–71. https://doi.org/10.1177/1527154417720935

Rocque, G., Blayney, D., Jahanzeb, M., Knape, A., Markham, T., Shelton, J., Sudheendra, P., & Evans, T. (2017, November 1). Choosing wisely in oncology: Are we ready for value-based care? Journal of Oncology Practice, 13(11), 935-943. https://ascopubs.org/doi/full/10.1200/JOP.2016.019281

Smith, T. (2020, January 10). What is value-based care? These are the key elements. American Medical Association. https://www.ama-assn.org/practice-management/payment-delivery-models/what-value-based-care-these-are-key-elements

Strazzabosco, M., Allen, J., & Tiesberg, E. (2017, January 10). Value-based care in hepatology. American Association for the Study of Liver Diseases, 65(5), 1749-1755. https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.29042

Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: A strategic framework. Academic Medicine, 95(5), 682–685. https://doi.org/10.1097/ACM.0000000000003122