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Lessons learned from value-based pediatric appendectomy care: A shared savings pilot model
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Lessons learned from value-based pediatric appendectomy care: A shared savings pilot model
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Journal Article
Lessons learned from value-based pediatric appendectomy care: A shared savings pilot model
2022
Overview
We aim to assess the healthcare value achieved from a shared savings program for pediatric appendectomy.
All appendectomy patients covered by our health plan were included. Quality targets were 15% reduction in time to surgery, length of stay, readmission rate, and patient satisfaction. Quality targets and costs for an appendectomy episode in two 6-month performance periods (PP1, PP2) were compared to baseline.
640 patients were included (baseline:317, PP1:167, PP2:156). No quality targets were met in PP1. Two quality targets were met during PP2: readmission rate (−57%) and patient satisfaction. No savings were realized because the cost reduction threshold (−9%) was not met during PP1 (+1.7%) or PP2 (−0.4%).
Payer-provider partnerships can be a platform for testing value-based reimbursement models. Setting achievable targets, identifying affectable quality metrics, considering case mix index, and allowing sufficient time for interventions to generate cost savings should be considered in future programs.
•Assessed the medical value of a Shared Savings Program for pediatric appendicitis.•Quality targets included time to surgery, length of stay, readmission, and patient satisfaction.•Two quality targets were met during the study period, readmission and satisfaction.•However, no savings were realized because the cost threshold was not met.•Payer-provider partnerships can be a platform for testing value-based reimbursement.
Publisher
Elsevier Inc,Elsevier Limited
Subject
/ Appendectomy - statistics & numerical data
/ Child
/ Childrens health insurance programs
/ Cost Savings - statistics & numerical data
/ Diagnosis-Related Groups - economics
/ Diagnosis-Related Groups - statistics & numerical data
/ DRGs
/ Health maintenance organizations
/ HMOs
/ Humans
/ Infant
/ Male
/ Medicaid
/ Medicare
/ Patient Readmission - economics
/ Patient Readmission - statistics & numerical data
/ Patients
/ Surgery
/ Value-Based Health Insurance - economics
/ Value-Based Health Insurance - statistics & numerical data
