Poor Performance in SNF-VBP Program is Associated with Worse COVID-19 Outcomes in Nursing Homes

Skilled Nursing Facility Value-Based Purchasing (SNF-VBP) was a new Medicare payment program when COVID-19 began. SNF-VBP aims to improve care through payment bonuses and penalties. However, studies have shown that minority-serving nursing homes (NHs) tend to fare worse under SNF-VBP (more likely to receive penalties, less likely to receive bonuses). This study sought to examine whether SNF-VBP performance prior to the pandemic was associated with COVID-19 outcomes and whether associations varied in NHs where the majority of residents are Black/African American (majority-Black/AA). Using publicly available data on COVID-19 outcomes and vaccinations, SNF-VBP performance, and NH characteristics, we found that majority-Black/AA NHs were less likely to have zero infections; had higher case fatality rates; and had lower resident and staff vaccinations rates compared to NHs where the majority of residents are White. Across all NHs, worse SNF-VBP performance was associated with worse COVID-19 outcomes (the bottom quintile of SNF-VBP performers were more likely to experience COVID-19 infections and had lower vaccination rates; the highest performers had higher vaccination rates). However, in stratified analyses, SNF-VBP performance was not significantly associated with COVID-19 outcomes in majority-Black/AA NHs compared with majority-White NHs. The association between poor SNF-VBP performance and poor COVID-19 outcomes is concerning. Overall findings suggest that SNF-VBP performance prior to the pandemic is an important indicator of subsequent COVID-19 outcomes. However, it is unclear whether poor SNF-VBP performance is signaling overall poor quality or whether it is signaling a financial disadvantage caused by the program itself that in turn impacted COVID-19 outcomes.

The Effects of Home Health Value-Based Purchasing on Home Health Care Quality in For-Profit and Nonprofit Agencies: A Comparative Interrupted Time-Series Analysis, 2012–2018

Beginning in 2016, the Home Health Value-Based Purchasing (HHVBP) model incentivized U.S. Medicare-certified home health agencies (HHAs) in nine states to improve quality of patient care and patient experience. Here, we quantified HHVBP effects upon quality over time (2012–2018) by HHA ownership (i.e., for-profit vs. nonprofit) using a comparative interrupted time-series design. Our outcome measures were Care Quality and Patient Experience indices composed of 10 quality of patient care measures and five patient experience measures, respectively. Overall, 17.7% of HHAs participated in the HHVBP model of which 81.4% were for-profit ownership. Each year after implementation, HHVBP was associated with a 1.59 ( p < .001) percentage point increase in the Care Quality index among for-profit HHAs and a 0.71 ( p = .024) percentage point increase in the Patient Experience index among nonprofits. The differences of quality improvement under the HHVBP model by ownership indicate variations in HHA leadership responses to HHVBP.

Recommendation for a Pilot MCDA Tool to Support the Value-Based Purchasing of Generic Medicines in the UAE

Introduction: In recent periods the United Arab Emirates (UAE) has strengthened economic measures in its pharmaceutical policy by promoting local manufacturing and facilitating the use of generic medicines. International examples indicate the importance of quality control elements in the implementation of cost containment policies. Multicriteria Decision Analysis (MCDA) is increasingly used in health care to facilitate health care decision based on multiple objectives. Our objective was to develop a pilot MCDA tool for repeated use to support the value-based purchasing of generic medicines in the UAE.Methods: An international evidence framework was adapted to UAE in a multistakeholder workshop organized by Dubai Health Authority. After validating the relevance of nine criteria in the local jurisdiction, participants decided the ranking and weight of each criterion by anonymous voting.Results: The top four criteria focused on quality elements starting with real-world clinical or economic outcomes (with 19.8% weight), followed by the quality assurance of manufacturing (17.3%), then evidence on the equivalence with the original product (14.8%), and drug formulation and stability (12.3%). The pharmaceutical acquisition cost criteria ranked fifth with 9.4% weight. The bottom four criteria, including reliability of drug supply, macroeconomic benefit, pharmacovigilance and added value services related to the product had similar weights in the range of 5.5–7.7%.Conclusion: Policy-makers in Dubai put high emphasis of value-based health care by incentivizing manufacturers of off-patent pharmaceuticals to generate additional scientific evidence compared to the mandatory minimum and acknowledging efforts to improve quality standards. The MCDA tool is considered suitable to improve the transparency and consistency of decision making in UAE for off-patent pharmaceuticals, and subsequently for other health technologies.

Advance Care Planning Protocols and Hospitalization Rates in Home Health Value-Based Purchasing

Advance care planning is a conversation about personal values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on advance care planning have taken place outside of home health among populations with HIV/AIDS, cancer, dementia, and end stage renal disease. The U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses, and hospitalization is a poor outcome. In 2016, Medicare implemented the Home Health Value-Based Purchasing Model, in which reimbursement rates for agencies in 9 regionally representative states were dependent on quantitative measures of quality performance. Part of the program was a process-level mandate requiring agencies to report on advance care planning. The aim of this study was to examine the relationship of home health advance care planning protocols with hospitalization rates. Descriptive and regression analyses were conducted on survey data of protocols and agency data of demographics and outcomes. Statistical significance was found in the positive correlation between advance care planning protocols and hospitalization. Recommendations are made for broadening the scope of evaluation of quality in home health to include goal-concordant care and transitions to appropriate services.