New Delhi: The National Health Authority (NHA) under its flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is introducing a new system to measure and grade hospital performance. The new initiative will introduce the concept of ‘value-based care’, where payment will be outcome-based and providers will be rewarded according to the quality of the treatment delivered. Under the new model, the providers will be rewarded for helping the patients improve their health, which consequently will reduce the effects of the disease in the population in the long term.
The new model aims to shift the focus of measuring hospital performance away from the volume of services provided and toward the value of healthcare services.
Speaking on the initiative, Dr RS Sharma, CEO, NHA, said, “To ensure PM-JAY beneficiaries receive both cashless healthcare benefits and high-quality care at every empanelled hospital, NHA has implemented various measures. These measures include standardising the cost of treatment under the scheme and adding new and advanced treatment procedures. Additionally, NHA has made a provision to incentivise best performing hospitals that provide quality care to patients.”
A case-based bundled payment is made based on the amount of services supplied, and historically, the healthcare model has been centered on the quantity of services offered from the payer’s perspective. This new step claims to significantly enhance the overall health gains for concerned stakeholders, including patients, healthcare providers, payers, and suppliers.
Under value-based care, the performance of AB PM-JAY empanelled hospitals will be measured based on five performance indicators, such as beneficiary satisfaction, hospital readmission rate, extent of out-of-pocket expenditure, confirmed grievances, and improvement in patients’ health-related quality of life.
The performance of the hospitals based on the above indicators shall also be made available on a public dashboard that will help the beneficiaries make an informed decision. As a result, the hospital’s performance will not only determine the hospital’s financial incentive but will also create a demand for quality treatment among PMJAY beneficiaries.
“In a value-based healthcare system, the payers can also exercise strong cost controls. Less demand on payers’ premium pools and investments results from a healthier population with fewer claims. It would be advantageous for suppliers if they could link their goods and services with improved patient outcomes and lower costs. Through these interventions of performance assessment and value-based incentives, the use of health technology assessment, and the use of digital tools to monitor the quality of care, aims to transform AB PM-JAY and the Indian health system from a volume-based to a value-based health care delivery system,” a statement from NHA added.