Currently Viewing:
ACO & Emerging Healthcare Delivery Coalition®
Currently Reading
Dr Justin Bachmann Discusses Consequences of Value-Based Care Being Done Incorrectly
January 06, 2018
Dr Shantanu Agrawal on the Challenge of Adjusting Measures for Social Risk Factors
December 14, 2017
Dr Mark Friedberg Discusses His Findings on Workplace Conditions in FQHCs
December 05, 2017
Barbara Balik: Why Clinician Burnout Needs to Be Addressed
November 29, 2017
Clay Alspach Explains How Changes in the FDA Will Affect Biosimilars
November 27, 2017
Dr Frank James: Working to Increase Access to Medication-Assisted Treatment
November 26, 2017
Barbara Balik Explains the Biggest Stressors That Cause Clinician Burnout
November 19, 2017
Dr Justin Bachmann: Challenges of Implementing Behavioral Interventions in Cardiac Care
November 18, 2017
Dr Frank James Discusses Responses to the Opioid Epidemic
November 11, 2017
Moving Specialties and the Whole Healthcare Industry to Value-Based Payment Models
November 01, 2017
Dr Frank James on Improving Treatment for Addiction
November 01, 2017
The Challenge of Adjusting Health Measures for Social Risk Factors
October 30, 2017
Navigating the Politics of the Healthcare Landscape
October 30, 2017
Making the Case for Integrated Care and Physician Engagement With Addiction Patients
October 30, 2017
Dr Shantanu Agrawal: Incorporating Social Risk Factors Into Performance Measures
October 28, 2017
5 Important Healthcare Issues Discussed at the ACO Coalition Meeting
October 28, 2017

Dr Justin Bachmann Discusses Consequences of Value-Based Care Being Done Incorrectly

Insufficient risk adjustment is a dangerous consequence of incorrectly implemented value-based care models, explained Justin Bachmann, MD, MPH, FACC, instructor of Medicine and Health Policy at Vanderbilt University Medical Center.


Insufficient risk adjustment is a dangerous a consequence of incorrectly implemented value-based care models, explained Justin Bachmann, MD, MPH, FACC, instructor of Medicine and Health Policy at Vanderbilt University Medical Center.

Transcript

How are value-based care models done incorrectly and what can be the consequences of those flaws?

I think the probably one of the real dangers of measuring value, I guess, inelegantly or perhaps incorrectly is just insufficient risk adjustment. Risk adjustment is never going to be perfect and at the end of the day we have to try to measure value. But if the risk adjustment is wildly imperfect then that can lead to patient selection and also sometimes provider selection.

For example, we know from prior episodes in New York and Pennsylvania in the early '90s, when mortality rates were reported on that were not sufficiently risk adjusted that led to a lot of patient selection. Patients—and this was demonstrated by an economist—who were sicker, providers were selecting patients who were healthier for procedures. Those were the types of change in behavior that you’ll see if there is insufficient risk adjustment.

I think the other thing that really has to be thought about and that people need to be cognizant of is the role of statistical variation in measuring value. Justin Dimick, MD, MPH, a health services researcher, posted a paper in 2006 in JAMA where he demonstrated that on average for a hospital center to be able to detect an increase of the mortality rate twice that of the national benchmark then that facility had to be doing about 270 bypasses and that’s over the course of 1 year. So that’s to detect an increase over the statistical margin of error. You start breaking that down at the provider level and pretty quickly you get within your error bars.

A lot of times when we talk about value-based care we talk about benchmarking, comparing providers to other providers, comparing facilities to other facilities, and there really almost always needs to be some other sort of error bar, some sort of measure so that people are actually cognizant of what is just random variation and what isn’t. If it’s within the error bar, it’s just random variation and one can’t be confidant of those results and they can lead to really, sometimes, dangerous conclusions.

 
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!