Value$-$Based Payment in a Physician Practice

Lowes Physician Practice, a group of primary and specialty physicians, has agreed to move away from fee$-$for$-$service methodology to value$-$based methodology. The local media in Lowes' service area made much fuss about the inefficiency of the U$.$S$.$ healthcare system and how fee$-$for$-$service reimbursement has created an incentive to provide more services to patients. There is little financial incentive in the current fee$-$for$-$service system for providers to coordinate patient care with other providers and verify that services provided are helping the patient. The media series $$High Cost$-$High Value?$$ set off a shock wave of alarm about costs and effective treatment in the local healthcare market. The proposed healthcare reforms were eagerly embraced by Lowes physicians.

Historically, Lowes$$ largest payer, Health Plan Excellence $($HPE$),$ which represents $60\%$ of the practice$$s payer mix, had not paid physicians or hospitals for preventive health services or for efforts to coordinate care with other providers. HPE has instead been paying for the diagnosis and treatment of medical conditions. That was now shifting. The value$-$based methodology is going to be centered on improved quality outcomes proposed by HPE.

What metrics would the payer likely use to assess quality?

A$.$

Patient$$s DRG assignment

B$.$

Percent of patients compliant in taking medications

C$.$

Average number of patients seen per physician hours worked

D$.$

Cost of care