Opportunities on the road to value-based payment for children with chronic respiratory disease

Area of Science:

• Health Services Research
• Pediatric Healthcare
• Healthcare Economics

Background:

• The US healthcare system is transitioning from fee-for-service (FFS) to value-based payment (VBP) models, accelerated by the Affordable Care Act.
• VBP models are projected to surpass FFS by 2020, significantly altering healthcare delivery.
• The current FFS model has created a healthcare infrastructure misaligned with the needs of children with chronic respiratory disease.

Purpose of the Study:

• To analyze the opportunities and risks of VBP models for children with chronic respiratory disease.
• To illustrate current and evolving payment models through case studies.
• To propose a novel framework for evaluating VBP models for this vulnerable population.

Main Methods:

• Review of current and evolving healthcare payment models.
• Analysis of limitations within existing payment structures.
• Development of a conceptual framework for VBP evaluation using fictional case studies.

Main Results:

• The shift to VBP presents both opportunities for better alignment with patient needs and risks of further misalignment if not carefully implemented.
• Current VBP models may not adequately address the complex, heterogeneous care requirements of children with chronic respiratory disease.
• Stakeholder input is crucial to prevent negative impacts on access to high-quality care.

Conclusions:

• Value-based payment models offer a chance to redesign healthcare delivery for children with chronic respiratory disease.
• A thoughtful, stakeholder-informed approach is necessary to ensure VBP models enhance, rather than compromise, care quality and access.
• A novel evaluation framework is proposed to guide the development and implementation of effective VBP models for pediatric chronic respiratory conditions.