New Delhi: National Health Authority (NHA) is introducing a new system to measure and grade hospital performance under the flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY). An objective to shift the focus of measuring performance of hospitals from volume of services provided to the value of healthcare services.
Traditionally, from the payer’s perspective, the health care model has focused on the quantity of services delivered, where a case-based bundled payment is made based on the number of services provided. The new initiative will introduce the concept of “value-based care,” where payment will be based on outcome and providers will be rewarded according to the quality of treatment provided. Under the new model, providers will be rewarded for helping patients improve their health, which in turn will reduce the long-term impact of disease in the population.
The move promises to significantly increase overall health benefits and is expected to benefit all stakeholders, from patients to healthcare providers, payers and suppliers. While patients achieve better health outcomes and greater satisfaction with the services they receive, providers want to achieve better efficiency of care. Similarly, payers will be able to maximize the health benefits arising from the expenditures incurred.
On the initiative of Dr. R. S. Sharma, Director General, National Health Authority said, “To ensure that PM-JAY beneficiaries receive both cashless health benefits and high quality care at each empaneled hospital, NHA has put in place various measures. These measures include standardizing treatment costs within the system and adding new and advanced treatments. In addition, the NHA has taken measures to incentivize top-performing hospitals that provide quality care to patients.”
In a value-based health care system, payers can also apply strict cost controls. A healthier population with fewer claims translates into less drain on premium funds and payer investment. Suppliers would benefit from being able to align their products and services with positive patient outcomes and lower costs. Overall, value-based care promises to significantly improve the healthcare landscape in India by incentivizing and encouraging healthcare providers to focus more on patient-centric service delivery.
Under value-based care, the performance of hospitals incorporating ABPMJAY will be measured based on five performance indicators such as,
- Beneficiary Satisfaction
- Hospital Readmission Rate
- The extent of Out-of-Pocket Expenditure
- Confirmed Grievances and
- Improvement in-patient’s Health-Related Quality of Life.
Hospital performance based on the above indicators will also be made available on a public information panel, which will help beneficiaries make an informed decision. The hospital’s performance will thus determine not only the hospital’s financial motivation, but also create demand for quality treatment for beneficiaries under PMJAY.
Together, these interventions of performance appraisal and value-based incentives, use of health technology assessment, and use of digital tools to monitor quality of care will transform ABPMJAY and the Indian healthcare system from volume to value. health care delivery system.
About Pradhan Mantri Jan Arogya Yojana (ABPMJAY)
Ayushman Bharat, a flagship scheme of the Government of India, was launched as recommended by the National Health Policy 2017 to achieve the vision of Universal Health Coverage (UHC). This initiative was designed to meet the Sustainable Development Goals (SDGs) and its underlining commitment to “leave no one behind”.
Ayushman Bharat is an attempt to shift from a sectoral and segmented approach of health service delivery to comprehensive need-based healthcare. This scheme aims to deliver breakthrough interventions to holistically address the health care system (comprising prevention, promotion and ambulatory care) at primary, secondary and tertiary levels. Ayushman Bharat takes a continuum of care approach that consists of two interrelated components which are Health and Wellness Centers (HWC) and Pradhan Mantri Jan Arogya Yojana (PM-JAY).
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