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Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative.

Publication ,  Journal Article
Joynt Maddox, K; Bleser, WK; Crook, HL; Nelson, AJ; Hamilton Lopez, M; Saunders, RS; McClellan, MB; Brown, N ...
Published in: Circulation. Cardiovascular quality and outcomes
May 2020

Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in improving HF care and examples of innovation in care redesign, the quality of HF care varies greatly across the country. One major challenge underpinning these issues is the current payment system, which is largely based on fee-for-service reimbursement, leads to uncoordinated, fragmented, and low-quality HF care. While the payment landscape is changing, with an increasing proportion of all healthcare dollars flowing through value-based payment models, no longitudinal models currently focus on chronic HF care. Episode-based payment models for HF hospitalization have yielded limited success and have little ability to prevent early chronic disease from progressing to later stages. The available literature suggests that primary care-based longitudinal payment models have indirectly improved HF care quality and cardiovascular care costs, but these models are not focused on addressing patients' longitudinal chronic disease needs. This article describes the efforts and vision of the multi-stakeholder Value-Based Models Learning Collaborative of The Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. The Learning Collaborative developed a framework for a HF value-based payment model with a longitudinal focus on disease management (to reduce adverse clinical outcomes and disease progression among patients with stage C HF) and prevention (an optional track to prevent high-risk stage B pre-HF from progressing to stage C). The model is designed to be compatible with prevalent payment models and reforms being implemented today. Barriers to success and strategies for implementation to aid payers, regulators, clinicians, and others in developing a pilot are discussed.

Duke Scholars

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Published In

Circulation. Cardiovascular quality and outcomes

DOI

EISSN

1941-7705

ISSN

1941-7713

Publication Date

May 2020

Volume

13

Issue

5

Start / End Page

e006483

Related Subject Headings

  • Value-Based Purchasing
  • Value-Based Health Insurance
  • Treatment Outcome
  • Time Factors
  • Stakeholder Participation
  • Quality Indicators, Health Care
  • Quality Improvement
  • Patient Readmission
  • Outcome and Process Assessment, Health Care
  • Models, Economic
 

Citation

APA
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Joynt Maddox, K., Bleser, W. K., Crook, H. L., Nelson, A. J., Hamilton Lopez, M., Saunders, R. S., … American Heart Association Value-Based Models Learning Collaborative, . (2020). Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative. Circulation. Cardiovascular Quality and Outcomes, 13(5), e006483. https://doi.org/10.1161/circoutcomes.120.006483
Joynt Maddox, Karen, William K. Bleser, Hannah L. Crook, Adam J. Nelson, Marianne Hamilton Lopez, Robert S. Saunders, Mark B. McClellan, Nancy Brown, and Nancy American Heart Association Value-Based Models Learning Collaborative. “Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative.Circulation. Cardiovascular Quality and Outcomes 13, no. 5 (May 2020): e006483. https://doi.org/10.1161/circoutcomes.120.006483.
Joynt Maddox K, Bleser WK, Crook HL, Nelson AJ, Hamilton Lopez M, Saunders RS, et al. Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative. Circulation Cardiovascular quality and outcomes. 2020 May;13(5):e006483.
Joynt Maddox, Karen, et al. “Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative.Circulation. Cardiovascular Quality and Outcomes, vol. 13, no. 5, May 2020, p. e006483. Epmc, doi:10.1161/circoutcomes.120.006483.
Joynt Maddox K, Bleser WK, Crook HL, Nelson AJ, Hamilton Lopez M, Saunders RS, McClellan MB, Brown N, American Heart Association Value-Based Models Learning Collaborative. Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative. Circulation Cardiovascular quality and outcomes. 2020 May;13(5):e006483.

Published In

Circulation. Cardiovascular quality and outcomes

DOI

EISSN

1941-7705

ISSN

1941-7713

Publication Date

May 2020

Volume

13

Issue

5

Start / End Page

e006483

Related Subject Headings

  • Value-Based Purchasing
  • Value-Based Health Insurance
  • Treatment Outcome
  • Time Factors
  • Stakeholder Participation
  • Quality Indicators, Health Care
  • Quality Improvement
  • Patient Readmission
  • Outcome and Process Assessment, Health Care
  • Models, Economic