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Research reveals lack of common language in value transformation of U.S. health care

Delphi panel finds distinct differences in the way common terms are understood by health care professionals, illustrating the complexity of concepts integral to health care transformation

Health care professionals, policymakers, and payers should consider differences when creating policy and implementing payment methodologies associated with value-based care and population health

PHILADELPHIA & LOUISVILLE, Ky.--(BUSINESS WIRE)--Today’s U.S. health policy initiatives, including those from the Centers for Medicare & Medicaid Services, are aiming to derive more value from the health care dollar. This involves a shift from reimbursement based on volume to reimbursement based on the value of care delivered.

With this shift comes a new set of terms being used across the industry, like value-based care and population health. Yet these terms have been found to hold different meanings for different stakeholders, and that has a variety of consequences for health care professionals, health care policymakers, patients, and payers, to name a few.

Humana Inc. (NYSE: HUM), one of the nation’s leading health and well-being companies, and Penn Medicine, set out to find consensus on three terms. Through the use of a Delphi research method that convenes a panel of experts to arrive at a group opinion or decision, lead researcher Marilyn Schapira, MD, MPH, led the panel through multiple rounds of surveys to achieve broadly applicable definitions for three terms: value-based care, value-based payment, and population health.

After more than six months, the Delphi panel reached consensus on the term value-based payment but, after three rounds of ratings, was unable to arrive at a consensus definition for value-based care and population health, though distinct areas of agreement and disagreement were made clear. These findings were presented June 3 at the AcademyHealth Annual Research meeting. See infographic that summarizes process and findings.

Findings illustrate complexity of concepts integral to transformation of health care

Researchers reviewed the peer-reviewed literature to collect current definitions in use to be evaluated by the Delphi panel. Then the panel met in person in early 2018 to discuss goals of the process and key components to use in the definitions. Ultimately, after three rounds of rating definitions and potential components for each of the terms, the Delphi panel achieved the following:

A consensus definition of value-based payment : “ Value-based payment aligns reimbursement with achievement of value-based care (health outcomes/cost) in a defined population with providers held accountable for achieving financial goals and health outcomes. Value-based payment encourages optimal care delivery, including coordination across health care systems and community resources, to improve health outcomes for both individuals and populations.”

No consensus definition for value-based care or population health , but specific areas of agreement and divergence became clear, illustrating the complexity of the concepts.

  Value-based care applies to individuals and populations and is determined by health outcomes and cost        
  • Whether to highlight the patient experience and perspective
  • Whether to include the time horizon over which value-based care is provided and the duration over which it is measured
  • The exact terms to use for the numerator and denominator of the value equation
  • Concept of societal constraints on resources
  • Population health refers to the distribution of health outcomes in a defined group of individuals.
  • Population can be defined by a range of factors that people have in common
  • Whether or how to include social and other determinants of health in the definition
  • Explicitly identifying different types of populations
  • Specifying domains of health or global outcomes (functional status, quality of life, wellness)

“We sponsored this research because, in talking with physicians and health systems, we were finding that increasingly the words we were each using to discuss value-based care and population health were incongruent. That was becoming more and more problematic as parties were coming together to discuss how care was being delivered, the way that care was being compensated, and the outcomes that care was achieving,” said William Shrank, MD, MSHS, Chief Medical Officer for Humana. “These findings illustrate the differences we, in the health care industry, should consider when creating policy and implementing payment methodologies associated with value-based care and population health.”

Delphi panel comprised esteemed leaders in health care

The Delphi process is a systematic, structured consensus-forming method using recognized experts who represent different perspectives relevant to the question posed. The Delphi process has proven useful to answer questions and address topics that cannot be addressed though clinical, experimental, or epidemiological methods. The Delphi process has been used in the past, for example, to define imaging procedures1, establish clinical consensus for the diagnosis and treatment of patients with certain pathologies2, and define advance care planning3.

Eighteen experts from a diverse range of professional backgrounds and geographic locations made up the Delphi panel to develop consensus statements for the terms value-based care, value-based payment, and population health. They included:

Alan Balch, PhD, National Patient Advocate Foundation; Richard J. Baron, MD, MACP, American Board of Internal Medicine; Patricia Barrett, MHSA, National Committee on Quality Assurance; Roy Beveridge, MD, Humana; Tracie Collins, MD, MPH, MHCDS, University of Kansas School of Medicine; Susan C. Day, MD, Penn Medicine; Rushika Fernandopulle, MD, MPP, Iora Health; Anders M. Gilberg, MGA, Medical Group Management Association; Douglas E. Henley, MD, FAAFP, American Academy of Family Physicians; Amy Nguyen Howell, MD, MBA, FAAFP, America’s Physician Groups; Christine Laine, MD, MPH, FACP, Annals of Internal Medicine, American College of Physicians; Christina Miller, MSS, Health Promotion Council of Southeastern Pennsylvania, Inc.; Jaewon Ryu, MD, JD, Geisinger Health System; Donald F. Schwarz, MD, MPH, MBA, Robert Wood Johnson Foundation; Mark Schwartz, MD, FACP, New York University; Jeffrey Stevens, MD, Summit Medical Group; Elizabeth Teisberg, PhD, Dell Medical School, University of Texas at Austin; Ken Yamaguchi, MD, MBA, Centene Corporation.

About Humana

Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

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  1. Boccardi M, Bocchetta M, Apostolova LG, et al. Delphi definition of the EADC-ADNI Harmonized Protocol for hippocampal segmentation on magnetic resonance. Alzheimers Dement. 2015;11(2):126-138.
  2. Bartlett SJ, Hewlett S, Bingham CO, 3rd, et al. Identifying core domains to assess flare in rheumatoid arthritis: an OMERACT international patient and provider combined Delphi consensus. Ann Rheum Dis. 2012;71(11):1855-1860.
  3. Sudore RL, Lum HD, You JJ, et al. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. J Pain Symptom Manage. 2017;53(5):821-832.e821.


Alex Kepnes
Humana Corporate Communications
(502) 580-2990

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