Hospital Value-Based Purchasing Case Study

Introduction
The Hospital Value Based Purchasing Program is a program by the Centers for Medicare and Medicaid Services (CMS). The initiative is intended to reward the acute care hospitals with incentive payments for the quality of the health care they give to individuals with Medicare. Through the HBV program, CMS has constantly changed the payment modal of hospitals, rewarding them for the quality of health care services they provide to Medicare patients and not only just the quantities of the procedures hospitals perform. They are rewarded based on how well they enhances patients' experiences of health care and how closely they adhere to best clinical practices. When they adhere to the standard guidelines and follow set best clinical practices,

the clients receive higher quality health care, which is subsequently reflected on better health outcomes.
Generally said, the program is an initiative by the CMS geared towards improving the quality of health care that Medicare beneficiaries receive. For the 2017 financial year, the payment of hospitals by the Hospital Value Based Purchasing Program (VBP) has been adjusted based on their performance (Blumenthal, D., & Jena, A. B., 2013).
How Our Facility Has Embraced VBP.
Montefiore Hospital, we have made great steps towards fully embracing and the implementation of the VBP.

In the quest for better and quality services, we have taken the following steps. First, integrating performance into our strategic objectives. We acknowledge that health care is definitely a complex, and adaptive systems where relationships and interactions of many different components simultaneously are affected and shaped by the system. As described, it is imperative to integrate performance improvements within the strategic objectives of the health care organization. Strategic objectives like focusing on populations health management, developing a center of excellence for cardiovascular services or even being an accountable health care organization (ACO), all need performance improvement so as to be

successful.
Secondly, we have restructured our population health management (the anatomy of services delivery) framework. The framework clearly indicates the various pathways clients can undergo in their interactions with the health care delivery system. It allows us to organize our thinking on the health care delivery process and to concentrate our attention on the decision making issues and the key processes.
Additionally, have developed cost variation. This is because at Montefiore Hospital, we believe that the idea is a good substitute for quality care since high costs result from delivery of unnecessary or inefficient care. As health care prescribers, clinicians are one of the major influencers in the management of the variable cost, which is a representation of direct costs in the departments. We therefore, concentrate on variable cost – by looking at the number of procedures and the cost per procedure, especially – identifying avoidable costs and working with clinicians using evidence-based practices to solve them.
Fourthly, we have prioritized our programs through a combination of an adoption system and analytics.

It is noted that to streamline operations and improve clinical outcomes successfully, you require a strong organizational structure and commitment, culture change, work flow processes and continuous staff education – what Health Catalyst refers to as an 'adoption system'. Our facility has embarked on this improvement journey and have assessed its readiness for change. Some examples of the criteria we have evaluated in assessing our readiness for change include, our shared vision, clinical leadership readiness, administrative support (such as outcome analyst availability, data manager) and data

availability.
In addition, at Montefiore we have established permanent performance improvement team. The team is responsible for reviewing and analyzing data, defining best practices and evidence-based practices, and monitoring ongoing result. We have also made sure that the