Value-Based Health Care in Undergraduate Medical Education

Factors influencing value-based care application among medical students and postgraduate in Thailand

BACKGROUND

The adoption of Value-Based Care (VBC) is essential for enhancing healthcare quality and efficiency, with implications for future healthcare delivery. The primary outcome of this study was to determine factors influencing the application of VBC principles among sixth-year medical students and postgraduate trainees in Thailand. Understanding these factors is essential for designing targeted educational interventions that prepare trainees for patient-centered healthcare practice.

METHODS

We conducted a cross-sectional study at the Faculty of Medicine, Prince of Songkla University, involving 90 participants, including 51 postgraduate trainees and 39 sixth-year medical students. Participants completed a comprehensive online questionnaire assessing their VBC-related attitudes, perceptions, intentions, and applications. Data analysis included descriptive statistics, Spearman correlation, and multiple linear regression.

RESULTS

Distinct differences in VBC application scores were evident between the two groups. Moderate associations were found between attitudes and perceptions (r = 0.44, p < 0.001), as well as between intentions and applications (r = 0.53, p < 0.001). Regression analysis identified family health history (β = 4.32, 95% CI: 0.69 to 7.94, p = 0.021) as a key predictor among sixth-year medical students, while financial security (β = 4.33, 95% CI: 1.69 to 6.97, p = 0.002) was significant for postgraduate trainees. Perception (β = 0.32, 95% CI: 0.10 to 0.54, p = 0.005) and intention (β = 0.42, 95% CI: 0.10 to 0.73, p = 0.011) were significant predictors for both groups, particularly among postgraduate trainees.

CONCLUSIONS

This study underscores the critical influence of personal and financial factors on VBC adoption among medical students and trainees. Integrating targeted educational strategies addressing these predictors could enhance VBC education, better preparing students for patient-centered healthcare practice.

Current status of healthcare financial literacy among medical trainees and junior hospitalists: An observational survey study

The absence of comprehensive education on hospital value-based purchasing during undergraduate medical education may lead to inadequate comprehension of healthcare finance during Graduate Medical Education and subsequent medical practice. Medicine residents and junior hospitalists (defined as those who completed their residency in the last 5 years) may lack essential healthcare financial skills to address the needs of their patients and the healthcare system effectively. To assess healthcare financial literacy among medical students, medicine residents, and junior hospitalists, we conducted a survey at an academic Internal Medicine residency affiliated with a US Medical School. Participants completed a 40-item questionnaire sourced from federal government healthcare system websites, providing demographic data and indicating prior formal healthcare finance education. Of the 126 respondents, only 15.6% reported receiving formal healthcare financial education, with merely 4 out of 34 junior hospitalists having prior education. Notably, there were no significant differences in correct answer percentages between 3rd and 4th-year medical students, medicine residents, and junior hospitalists across 3 domains: Medicaid/Medicare insurance, US healthcare systems & insurance, and healthcare access, quality and value-based purchasing. However, participants performed better in the domain of Medicaid/Medicare insurance compared to the other domains. This study underscores the potential deficiency in financial skills among junior healthcare providers, highlighting the importance of addressing this gap to ensure effective patient care.

The Academic Payvider Model: Care and Coverage

The US health care system has significant room for growth to achieve the Quintuple Aim. Reforming the relationship between payers and providers is pivotal to enhancing value-based care (VBC). The Payvider model, a joint approach to care and coverage rooted in vertical integration, is a potential solution. The authors aimed to investigate academic medical institutions adopting this model, termed Academic Payviders. All Association of American Medical Colleges (AAMC)-member allopathic medical schools were evaluated to identify programs meeting the inclusion criteria of offering both medical care and insurance coverage to patients via partnership with a payer or ownership of, or by, a payer. Twenty-five Academic Payvider systems were identified from 171 total AAMC-member programs. Most programs were founded after 2009 (n = 20), utilized a provider-dominant structural model (n = 17), and offered health plans to patients via Medicare Advantage (n = 23). Passage of the Affordable Care Act, recent trends in health care consolidation, and increased political and financial prioritization of social determinants of health (SDOH) may help to explain the rise of this care and coverage model. The Academic Payvider movement could advance academic medicine toward greater acceptance of VBC via innovations in medical education, resource stewardship in residency, and the establishment of innovative leadership positions at the administrative level.

Shifting from Conventional Curriculum to Value-based Medical Curriculum: Narrative Review

Value-based medical education is essential for the provision of quality-assured patient-centered healthcare services. The purpose of the current review is to explore the need for the adoption of a value-based approach in medical curriculum, identify the merits, devise a stepwise plan for the implementation of a value-based curriculum, and identify the potential concerns and the strategies to overcome them. The implementation of a value-based approach in medical curricula requires a systematic and stepwise approach to ensure the attainment of maximum benefits. However, this implementation can be accompanied by multiple challenges, and we will require the active involvement of medical educators and college administrators to overcome them. The delivery of value-based medical education is expected to prepare the future cohort of healthcare professionals to deliver patient-centered care. This calls for the need to adopt a multipronged approach to ensure that this value-driven teaching is integrated into the existing model of delivery of medical education, as it will significantly improve patient outcomes and well-being.

"The Water in Which We Swim:" A Unique, Post-Clerkship Multidisciplinary Course

OBJECTIVE

To improve patient outcomes and promote health equity, medical students must be taught not only biomedicine, but also the social sciences to understand the larger contexts in which patients live and health care operates. Yet, most undergraduate medical education does not explicitly cover these topics in a required, longitudinal curriculum.

METHODS

In January 2015 at Harvard Medical School, we created a two-part sequence (pre- and post-clerkship) of required, 4-week multidisciplinary courses-"Essentials of the Profession I and II"-to fill this gap. "Essentials of the Profession II (EOP2)" is an advanced social sciences course anchored in patient narratives and the lived experiences of students and includes clinical epidemiology and population health, healthcare delivery and leadership, health policy, medical ethics and professionalism, and social medicine that engages students to conduct structural analyses to be effective healers, advocates, and leaders.

RESULTS

Per student course evaluations, the overall course rating was 1.7 (SD 0.9, 1 = excellent and 5 = poor); its overall rating has improved over time; and it has scored well even when run virtually. It was rated highly in application of critical thinking, integration of the disciplines, and relevance for clinical work. Qualitative analyses of student responses revealed the following key course strengths: breadth of topics, teaching faculty and guest speakers, and small group discussions. The weaknesses included workload, lack of diversity of opinions, repetition, and time spent in lectures.

CONCLUSIONS

We argue that EOP2 is "essential" for post-clerkship medical education. It offers an opportunity to re-ignite and enhance humanism and activism; remind students why they chose the medical profession; equip them with frameworks and toolkits to help them to overcome challenges; and devise solutions to improve health care and patient outcomes that are applicable to their future training and ongoing practice of medicine.

Pre-doctoral dental faculty perceptions toward value-based care: An exploratory study

OBJECTIVES

To explore pre-doctoral faculty perceptions toward implementation of value-based care (VBC) in didactic and clinical teaching.

METHODS

This project was a collaborative effort between CareQuest and the University of North Carolina at Chapel Hill, Adams School of Dentistry introducing VBC to pre-doctoral dental faculty as part of a new curriculum. Following a faculty development session on VBC in June 2021, faculty and subject matter experts were invited to participate in qualitative interviews. Subject matter experts were interviewed to establish a baseline for VBC knowledge and understanding. Interviews were recorded and transcribed verbatim. Analysis was conducted by two analysts using ATLAS.ti and a thematic analysis approach.

RESULTS

Six faculty and two subject matter experts participated in interviews. Although dental faculty demonstrated some understanding of VBC, they recognized that more training is required to build in-depth knowledge and implementation strategies for teaching dental students. Faculty discussed value-based concepts such as prevention-focused teaching, person-centered care, and disease management over invasive restoration of teeth, and how VBC is bringing about a paradigm shift in dentistry that needs to be reflected in dental education. They acknowledged a disconnect between VBC in didactic teaching versus clinical instruction. Those interviewed believed it would take time to shift faculty mindset and readiness to teach VBC, and continued efforts are needed at the leadership and faculty level for acceptance and implementation.

CONCLUSIONS

Although dental faculty recognize that VBC can bring a shift in dental practice, more training and guidance to implement it in didactic and clinical teaching is needed.

Incorporating value-based healthcare projects in residency training: a mixed-methods study on the impact of participation on understanding and competency development

OBJECTIVES

Stimulating the active participation of residents in projects with societally relevant healthcare themes, such as value-based healthcare (VBHC), can be a strategy to enhance competency development. Canadian Medical Education Directions for Specialists (CanMEDS) competencies such as leader and scholar are important skills for all doctors. In this study, we hypothesise that when residents conduct a VBHC project, CanMEDS competencies are developed. There is the added value of gaining knowledge about VBHC.

DESIGN

An explorative mixed-methods study assessing residents' self-perceived learning effects of conducting VBHC projects according to three main components: (1) CanMEDS competency development, (2) recognition of VBHC dilemmas in clinical practice, and (3) potential facilitators for and barriers to implementing a VBHC project. We triangulated data resulting from qualitative analyses of: (a) text-based summaries of VBHC projects by residents and (b) semistructured interviews with residents who conducted these projects.

SETTING

Academic and non-academic hospitals in the Netherlands.

PARTICIPANTS

Out of 63 text-based summaries from residents, 56 were selected; and out of 19 eligible residents, 11 were selected for semistructured interviews and were included in the final analysis.

RESULTS

Regarding CanMEDS competency development, the competencies 'leader', 'communicator' and 'collaborator' scored the highest. Opportunities to recognise VBHC dilemmas in practice were mainly stimulated by analysing healthcare practices from different perspectives, and by learning how to define costs and relate them to outcomes. Finally, implementation of VBHC projects is facilitated by a thorough investigation of a VBHC dilemma combined with an in-depth stakeholder analysis.

CONCLUSION

In medical residency training programmes, competency development through active participation in projects with societally relevant healthcare themes-such as VBHC-was found to be a promising strategy. From a resident's perspective, combining a thorough investigation of the VBHC dilemma with an in-depth stakeholder analysis is key to the successful implementation of a VBHC project.