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Value in Health Care Framework, Michael Porter NEJM 2010; 363 (Defining…
Value in Health Care Framework, Michael Porter NEJM 2010; 363
Intro
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IOM goals: safe, effective, patient centered, timely, efficient, equitable
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Measuring Value
What is Quality?
"current" quality means adherence to evidence-based guidelines, majority are process measures
safety does not equal quality, but safety is important but one aspect of quality and one type of outcome
Donabedian model: structure, process, outcome
structure, process, health indicators, outcome; where indicators are biologic measures that predict outcomes
structure, process, health indicators, patient compliance, outcome
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patient satisfaction survey for patient compliance and health outcomes perceived by patient (functional status, pain, anxiety, etc)
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Value and Reimbursement
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not fee for service, and not general capitation, but bundled payment for the care of medical conditions over the care cycle
Defining value
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better quality lowers costs, "quality is free"
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