An Example of Translating Value-Based Purchasing Into Value-Based Care

Area of Science:

• Health Policy
• Healthcare Management
• Nursing Leadership

Background:

• The Affordable Care Act (ACA) established Medicare Value-Based Purchasing (VBP) to ensure accountability for high-quality, cost-effective care.
• The Centers for Medicare and Medicaid Services (CMS) defined quality measures aligned with national strategic objectives.
• Initial VBP quality measures focused on Clinical Process and Patient Experience of Care.

Purpose of the Study:

• To explore the role of nursing in VBP initiatives.
• To examine the potential for innovative care delivery models within VBP.
• To highlight the shift towards preventative and population-focused care.

Main Methods:

• Analysis of the ACA's VBP framework.
• Review of CMS quality measure specifications.
• Synthesis of literature on nursing's role in VBP and healthcare transformation.

Main Results:

• VBP provides a platform for healthcare buyers to hold providers accountable.
• Quality measures are expanding to include care models and community-based health promotion.
• Nursing is positioned to lead the development of innovative, cost-effective care models.

Conclusions:

• Value-based purchasing empowers nursing to drive quality improvement and cost reduction.
• Nursing can lead the transition from sick care to population-focused, preventative health.
• Innovative care models are essential for achieving VBP goals and promoting wellness.