Transitioning from Fee-for-Service to Value-Based Care

The United States healthcare system is undergoing an aggressive reform push to eliminate inefficiencies and maximize existing scarce resources. The shift towards value-based care is one of the highlights of this healthcare reform agenda.

Traditionally, healthcare providers in the United States were primarily motivated by the volumes and profits, ignoring the nature and quality of outcomes. Today, healthcare providers are encouraged to seek resource efficiency while improving the quality of care and patient outcomes.

Value-based care is defined by a philosophy to expand access to care and create an optimal healthcare system. It differs from fee-for-service in that it redefines the principles that guide medical practice. Specifically, value-based care calls attention to aspects of care such as quality and proactive interventions that help manage the excesses typical to the health system.

For instance, value-based care is founded on the realization that reactive health interventions are expensive and result in poor care outcomes because diseases are at an advanced stage. Value-based care encourages proactive and evidence-based interventions that improve costs and patient outcomes. In addition, value-based care has been shown to compel healthcare providers towards inter-professional collaboration and the integration of care practices.

Despite the vast advantages envisioned from the transition to value-based care, there is a need to invest in resources that enable the model. One of the challenges to value-based care is the presence of resource limitations that challenge the implementation of tools critical to value-based care’s success. For instance, aspects of value-based care such as medical homes, accountable care organizations, and capitation rely on sufficient financial and human resources access.

These challenges are made more difficult by the expected shortage of nurses who make up the largest workforce in healthcare. According to the US Bureau of Labor, an estimated 11 million nursing professionals are needed to avert a looming shortage. The Association of American Medical Colleges has also raised similar concerns indicating that by the year 2034, the health industry could contend with physician shortages as high as 124,000. These concerns create the need for state and non-state actors to step in and help ease the resource deficiencies that challenge the industry.

Despite the foreseen challenges, value-based care has numerous advantages. First, the model’s proactive nature means that disease states are identified before they advance to more complex stages. This way, value-based care helps to minimize patient suffering.

Again when healthcare providers prioritize cost-efficient care strategies such as prevention, there are fewer resources used in the course of care provision. This efficiency substantially improves the bottom line by eliminating resource wastage in re-admissions and high drug subscription costs. Most importantly, value-based care aligns with healthcare’s original mission to heal and improve society’s wellbeing. The shift to value-based care re-imagines the healthcare industry’s mandate by prioritizing value and quality over profit maximization.

Since value-based care seeks to operationalize processes and systems that improve patient outcomes and facilitate the efficient use of healthcare resources, it will help reverse the inefficiencies created by years of a health system founded on profit. While some might view value-based care as the beginnings of a social healthcare system, the trade-offs in social value are evident.

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Understanding Integrated CKD and ESRD Programs

Patients with Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) are continuously faced with increasing costs and demanding treatment plans that make treatment an overwhelming experience. This becomes more difficult when a patient has to deal with different physicians from different facilities who do not have the means to communicate with each other concerning a patient effectively.

The transition from one healthcare to another is costly for kidney patients and may result in poor health outcomes. The progression of patients from the advanced CKD stage to ESKD is also linked to clinical instability and prolonged hospitalization. The move from one health facility to another as a patient seeks medical attention for different conditions also presents a risk of delayed treatment in a situation requiring immediate attention. These challenges present the need for coordinated care to help improve patient care quality.

Luckily, the introduction of integrated care that offers a holistic approach by considering various factors that make up treatment plans for kidney care is a promising solution. The integrated care model is based on value-based care where a healthcare provider is paid as per the patient outcome rather than how many services were administered. It also involves addressing a patient’s healthcare needs in one place and offering a better patient experience as it saves them from the logistics burden and offers coordinated care.

The integrated care is a welcome move considering that patients with advanced CKD also experience co-morbid (additional conditions) diseases, such as diabetes and cardiovascular diseases, that require treatment, adding to an already mentally and physically stressful treatment plan. Each disease requires a patient to visit different doctors and even have several care plans. The needs for End-Stage Renal Disease (ESRD) patients are even more complex as they also require frequent dialysis treatments to sustain life.

However, with integrated care, disease management becomes convenient. A good example of an integrated program for patients with kidney failure is the ESRD Seamless Care Organization (ESCO), a model whereby Medicare assigns a patient to an ESCO based on facilities where they go for dialysis. ESCO takes responsibility for all treatment costs for an ESRD patient. The ESCOs are part of the Comprehensive ESRD Care Model established to develop better ways to improve the care given to patients under Medicare.

Aside from ensuring reduced cost for healthcare costs, integrated kidney care serves to educate the patients on treatment options and other related information, helps avoid unnecessary hospitalization, and helps to lower the rate of unplanned dialysis starts. This has been made possible through actionable data analytics that physicians can use to make better-informed decisions when handling patients.

Since an integrated care model addresses the needs of the kidney patients in one location and reduces the logistics burden, a patient will receive quick care and hence better health outcome. Through integrated care, it is possible to maintain continuity and consistency in-inpatient medical records making it possible to track patient treatment and progress, which improves the overall patient experience.

Whereas traditional fee-based services may lead to prolonged treatments as physicians seek to maximize payments, integrated care focuses on the outcome of a service. Thus, combining integrated care with value-based care contributes to innovative solutions specific to different patient needs.

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An Overview of Hansen's Disease

Leprosy became known as Hansen's disease in 1873 when Norwegian scientist Gerhard Henrik Armauer Hansen discovered Mycobacterium leprae, the slow-growing bacteria that causes the illness. Affecting the nerves, skin, and lining of the nose, the condition is curable with early diagnosis and treatment.

Once thought to be very contagious and deadly, we know now that leprosy is not easily transmitted and that treatment is efficient. The leprosy-causing bacteria target the nerves, causing them to swell beneath the skin. This results in the affected areas losing their ability to experience feeling and pain, which can lead to injuries such as cuts. The affected skin usually changes color, becoming lighter, darker, or reddish due to inflammation.

Delays in diagnosis and treatment can result in serious consequences, including muscle weakness and deformity. Physical and neurological damage may be irreversible even if the condition is healed, thus early discovery is critical.

Scientists do not know exactly how Hansen’s disease spreads. It may happen when an infected person coughs or sneezes, and a healthy person breathes in the droplets containing the bacteria. However, people cannot catch leprosy by shaking hands or hugging, and mothers cannot transmit the disease to their unborn children.

Hansen's disease primarily affects people living in low-income countries. Due to high expenditures of traveling to the doctor, many people have trouble getting health care. As a result, despite the World Health Organization's (WHO) free treatment program, many do not receive medical care.

People with Hansen's disease may not seek care when the first symptoms arise because of the associated ongoing stigma, resulting in a delay in diagnosis. To successfully eliminate the stigma associated with the disease, education and improved access to basic health services are essential.

People anywhere in the world have an extremely low probability of contracting Hansen's disease. More than 95 percent of the population is naturally immune.

To confirm a diagnosis, doctors take a skin biopsy or nerve biopsy. They also may perform tests to rule out other skin diseases.

Endorsed by the WHO in 1981, multidrug therapy (MDT) including antibiotics is used to treat the disease. Medications can also reduce the chance of contracting leprosy for those who live with people who have the disease. The current MDT protocol consists of three medications: dapsone, rifampicin, and clofazimine. After a few days of antibiotic treatment, a person with leprosy is no longer contagious.

To ensure that the infection does not return, the treatment must be completed as directed by doctors. The course of treatment normally lasts one to two years. While the treatment can cure the disease and keep it from worsening, it cannot undo nerve damage or physical disfigurement that has already occurred, and diagnosing the disease as soon as possible is critical to prevent permanent nerve damage.

Every year, on the final Sunday in January, World Leprosy Day is commemorated. Started by French philanthropist Raoul Follereau, in 1954, it aims to raise leprosy awareness and teach people about an old disease that can be cured in today’s world.

Benefits of Joining a Gym

Americans spend an estimated $33 billion at gyms, health centers, health clubs, and studios each year. Going to the gym has several advantages, whether with a paid or free membership. In addition to working on a defined physique, the person has the opportunity to meet like-minded people and be in an environment that inspires a person to commit to working out.

Whether paying for a membership or through a free membership, going to the gym can have a few advantages. Last year, when many found themselves having to budget, gym memberships moved downward. Data from Run Repeat shows that 72.14 percent of those who had gym memberships before 2020 found another way to exercise, and 39.14 percent of avid gym goers let their membership lapse and bought home fitness equipment.

As of March 2021, many of these people had failed to return to the gym, with almost 71 percent reporting not returning to their gyms and nearly 40 percent of gym members stating they had no intention of returning. Last year many were forced to find other ways to remain fit, but now that the gyms are open, gym memberships hold many advantages over alternatives.

Many gyms hire trained professionals to provide their members with individual or group instruction. The instructor shows the gym member the proper form to lift weights to prevent back issues, muscle strains, and other injuries in individual instruction. Meanwhile, group classes offered through a gym are another guidance-related benefit. Group classes provide participants guidance to perform particular exercises and opportunities for socialization.

According to a University of New England College of Osteopathic Medicine study cited in a 2017 Shape article, those who enrolled in workout classes reported they experienced less stress and a better quality of life than those who did not. The study spanned 12 weeks and involved medical students split into three groups, each given a different fitness regimen. The first group participated in one group class a week, group two worked out alone or with one or two partners twice a week, and the last group engaged in no exercise.

The students reported their experience on three surveys, each survey given every four weeks. The first group (class participants) reported lower stress levels and improved physical, mental, and emotional quality of life. Those who exercised but not in group classes (Group 2) only experienced an increase in their quality of life. Finally, those who did not work out saw no change in either quality of life or stress levels.

One of the reasons this might be is because collective exercise where individuals engage and interact with each other during gym hours engenders a sense of community in those who attend the gym regularly, whether working out alone or in classes. Ultimately, these interactions can culminate in finding supportive people who inspire the desire to be fit.

Finally, the gym also offers members the chance to choose from various amenities, depending on the gym. Gyms typically provide free weights and machines and provide different elliptical machines. The gym might also have a pool and other amenities, depending on the size.