Value-Based Pay-for-Performance Gaps in the Care Delivery Framework for a Large-Scale Health System

Area of Science:

• Healthcare Management
• Value-Based Care
• Preventive Health

Background:

• Health systems face increasing pressure from pay-for-performance agreements.
• These agreements often focus on improving ambulatory preventive screenings, termed gaps in care.
• Gaps in care are commonly measured using Healthcare Effectiveness Data and Information Set (HEDIS) quality measures.

Purpose of the Study:

• To describe a physician-led program designed to effectively address gaps in care.
• To highlight the importance of a structured framework in managing value-based care initiatives.

Main Methods:

• Implementation of a structured framework within a physician-led Gaps in Care program.
• Focus on improving key processes: measurement, data attribution, patient outreach, and patient engagement.

Main Results:

• The program successfully improved processes related to addressing patient gaps in care.
• A structured approach facilitates the complex delivery of value-based care.

Conclusions:

• A structured framework is a successful strategy for managing patient gaps in care.
• Effective management of gaps in care is crucial for achieving value-based care goals.