New Delhi: Aiming to shift the focus of measuring performance of hospitals from volume of services provided to the value of healthcare services, the National Health Authority (NHA) has introduced a new system to measure and grade performance of hospitals under the flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
As per the Health Ministry’s statement, 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 disease in the population in the long term, it said.
The step promises significant increase in the overall health gains and is expected to be a win-win for all concerned stakeholders from patients to healthcare providers, payers and suppliers, the statement said. While the patients will get better health outcomes and higher satisfaction out of the services they receive, providers stand to get better care efficiencies. Similarly, payers will be able to maximize the health benefits generated out of the spending incurred.
“To ensure PM-JAY beneficiaries receive both cashless healthcare benefits and high-quality care at every empanelled hospital, NHA has implemented various measures, which include standardising the cost of treatment under the scheme and adding new and advanced treatment procedures. NHA has made a provision to incentivise best performing hospitals that provide quality care to patient,” said Dr RS Sharma, CEO, National Health Authority.
In a value-based healthcare system, the payers can also exercise strong cost controls. A healthier population with fewer claims translates into less drain on payers’ premium pools and investments. Suppliers would benefit from being able to align their products with positive patient outcomes, reduced cost. Under value-based care, the performance of AB PM-JAY empanelled hospitals will be measured based on five performance indicators - beneficiary satisfaction, hospital readmission rate, extent of out-of-pocket expenditure, confirmed grievances, improvement in-patient’s health-related quality of life.