Lessons learned from value-based pediatric appendectomy care: A shared savings pilot model

Area of Science:

• Healthcare Management
• Value-Based Care
• Pediatric Surgery

Background:

• Shared savings programs aim to align payer and provider incentives for improved healthcare value.
• Assessing the financial and quality outcomes of such programs is crucial for optimizing healthcare delivery.

Purpose of the Study:

• To evaluate the healthcare value generated by a shared savings program specifically for pediatric appendectomy procedures.
• To determine if quality targets and cost reduction goals were met within the program's performance periods.

Main Methods:

• A retrospective analysis of all pediatric appendectomy patients within a health plan was conducted.
• Quality targets included reductions in time to surgery, length of stay, readmission rates, and improvements in patient satisfaction.
• Performance was compared across baseline and two 6-month performance periods (PP1, PP2).

Main Results:

• No quality targets were achieved in the first performance period (PP1).
• In the second performance period (PP2), readmission rates decreased by 57% and patient satisfaction improved, meeting two quality targets.
• Despite quality improvements, the program did not achieve cost savings as the -9% cost reduction threshold was not met in either PP1 (+1.7%) or PP2 (-0.4%).

Conclusions:

• Payer-provider collaborations offer a framework for testing value-based reimbursement models in pediatric surgery.
• Future shared savings programs should focus on setting achievable quality targets, identifying key performance indicators, accounting for case mix, and allowing adequate time for interventions to demonstrate cost savings.