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Leao DLL, Pavlova M, Groot WNJ. How to facilitate the introduction of value-based payment models? Int J Health Plann Manage 2024; 39:583-592. [PMID: 38123527 DOI: 10.1002/hpm.3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/02/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Value-based payment (VBP) models are designed and implemented to improve outcomes at the same or lower costs. Their adoption requires significant changes in the way healthcare organisations and insurance companies operate. Usually, before VBP models are widely implemented, pilot projects are conducted. Payers need to have a comprehensive set of requirements to enter into agreements with healthcare organisations on these pilots. In this short communication, we outline key elements reported in the literature, inside and outside healthcare organisations, as well as within the contract, that need to be considered in a pilot VBP model. Discussions regarding the introduction of VBP models may be strongly affected by external contextual factors, including regulations, which are outside the control of healthcare organisations. It requires collaboration between organisations, including primary care organisations and hospitals, while within organisations, it frequently requires creating multidisciplinary teams. The focus is on ensuring transparency, collaboration, and shared decision-making, realised by standardising communication processes and regular meetings. Additionally, effective leadership is needed, in which leaders set goals and priorities, as well as manage change. In the contractual agreements between payers and healthcare organisations, outcome measures need to be adequately defined and measured, including individual patient outcomes and composite scores, as well as absolute and relative performance measures. These measures should be tested periodically and catered to the organisations adopting the model. Also, incentives should have adequate size and frequency and be intrinsic and extrinsic. The consideration of these sets of key elements by the payers is essential when implementing VBP model pilot projects.
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Affiliation(s)
- Diogo L L Leao
- Department of Health Services Research, CAHPRI, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAHPRI, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Wim N J Groot
- Department of Health Services Research, CAHPRI, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Gleason KT, Powell DS, Wec A, Zou X, Gamper MJ, Peereboom D, Wolff JL. Patient portal interventions: a scoping review of functionality, automation used, and therapeutic elements of patient portal interventions. JAMIA Open 2023; 6:ooad077. [PMID: 37663406 PMCID: PMC10469545 DOI: 10.1093/jamiaopen/ooad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives We sought to understand the objectives, targeted populations, therapeutic elements, and delivery characteristics of patient portal interventions. Materials and Methods Following Arksey and O-Malley's methodological framework, we conducted a scoping review of manuscripts published through June 2022 by hand and systematically searching PubMed, PSYCHInfo, Embase, and Web of Science. The search yielded 5403 manuscripts; 248 were selected for full-text review; 81 met the eligibility criteria for examining outcomes of a patient portal intervention. Results The 81 articles described: trials involving comparison groups (n = 37; 45.7%), quality improvement initiatives (n = 15; 18.5%), pilot studies (n = 7; 8.6%), and single-arm studies (n = 22; 27.2%). Studies were conducted in primary care (n = 33, 40.7%), specialty outpatient (n = 24, 29.6%), or inpatient settings (n = 4, 4.9%)-or they were deployed system wide (n = 9, 11.1%). Interventions targeted specific health conditions (n = 35, 43.2%), promoted preventive services (n = 19, 23.5%), or addressed communication (n = 19, 23.4%); few specifically sought to improve the patient experience (n = 3, 3.7%). About half of the studies (n = 40, 49.4%) relied on human involvement, and about half involved personalized (vs exclusively standardized) elements (n = 42, 51.8%). Interventions commonly collected patient-reported information (n = 36, 44.4%), provided education (n = 35, 43.2%), or deployed preventive service reminders (n = 14, 17.3%). Discussion This scoping review finds that most patient portal interventions have delivered education or facilitated collection of patient-reported information. Few interventions have involved pragmatic designs or been deployed system wide. Conclusion The patient portal is an important tool in real-world efforts to more effectively support patients, but interventions to date rely largely on evidence from consented participants rather than pragmatically implemented systems-level initiatives.
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Affiliation(s)
- Kelly T Gleason
- Johns Hopkins University School of Nursing, Baltimore, MD 21225, United States
| | - Danielle S Powell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Aleksandra Wec
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Xingyuan Zou
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, MD 21225, United States
| | - Danielle Peereboom
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
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Menear M, Duhoux A, Bédard M, Paquette JS, Baron M, Breton M, Courtemanche S, Dubé S, Dufour S, Fortin M, Girard A, Larouche-Côté É, L'Espérance A, LeBlanc A, Poitras ME, Rivet S, Sasseville M, Achim A, Archambault P, Bajurny V, Brown JB, Carrier JD, Côté N, Couturier Y, Dogba MJ, Gagnon MP, Ghio SC, Marshall EG, Kothari A, Lussier MT, Mair FS, Smith S, Vachon B, Wong S. Understanding the impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity: protocol for a mixed methods study. BMC PRIMARY CARE 2023; 24:154. [PMID: 37488515 PMCID: PMC10364355 DOI: 10.1186/s12875-023-02106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients' care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences. METHODS We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases. DISCUSSION Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.
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Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada.
- VITAM Centre de recherche en santé durable, Quebec City, Canada.
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
- Centre de Recherche Charles-Le Moyne, Montreal, Canada
| | - Myreille Bédard
- Person With Lived Experience (Patient Partner), Montreal, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie Baron
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Savannah Dubé
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Stefany Dufour
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Ariane Girard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Eve Poitras
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Sophie Rivet
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Maxime Sasseville
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | - Amélie Achim
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Department of Psychiatry, Université Laval, Quebec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Virtue Bajurny
- Person with Lived Experience (Patient Partner), Toronto, Canada
| | | | - Jean-Daniel Carrier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nancy Côté
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Social Sciences, Université Laval, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Pierre Gagnon
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | | | | | - Anita Kothari
- Department of Health Studies, Western University, London, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, UK
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | - Sabrina Wong
- Faculty of Applied Science, University of British Colombia, Vancouver, Canada
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