With a view to shift the focus of measuring performance of hospitals from volume of services provided to the value of healthcare services, 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 (AB PM-JAY).
Traditionally, from the payer's perspective, the healthcare model has been focussed on the quantity of services delivered, where case-based bundled payment is made on the basis of the number of services provided.
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. 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 maximise the health benefits generated out of the spending incurred, said officials.
Speaking on the initiative R.S. Sharma, CEO, National Health Authority 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."
In a value-based healthcare system, the payers can also exercise strong cost controls. Officials said that 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 and services with positive patient outcomes and reduced cost. Altogether, value-based care promises to significantly improve healthcare landscape in India by incentivizing and encouraging healthcare providers to focus more on delivering patient centric services.
Under value-based care, the performance of AB PM-JAY empanelled hospitals will be measured based on five performance indicators, including Beneficiary Satisfaction; Hospital Readmission Rate; the extent of Out-of-Pocket Expenditure; Confirmed Grievances and Improvement in-patient's Health-Related Quality of Life.
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. 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 maximise the health benefits generated out of the spending incurred, said officials.
Speaking on the initiative R.S. Sharma, CEO, National Health Authority 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."
In a value-based healthcare system, the payers can also exercise strong cost controls. Officials said that 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 and services with positive patient outcomes and reduced cost. Altogether, value-based care promises to significantly improve healthcare landscape in India by incentivizing and encouraging healthcare providers to focus more on delivering patient centric services.
Under value-based care, the performance of AB PM-JAY empanelled hospitals will be measured based on five performance indicators, including Beneficiary Satisfaction; Hospital Readmission Rate; the extent of Out-of-Pocket Expenditure; Confirmed Grievances and Improvement in-patient's Health-Related Quality of Life.