Value transformation framework model seeks to guide transition to value-based healthcare

With a new focus on quality of care and outcomes achieved, healthcare organizations are challenged to make the transition to value-based care. A model called the Value Transformation Framework (VTF) provides a structured, step-by-step approach to help guide the shift to value-based healthcare, reports a paper in the Journal for Healthcare Quality (JHQ), the peer-reviewed journal of the National Association for Healthcare Quality (NAHQ). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"The VTF framework shows promise in supporting health center efforts to adapt, transform, and balance competing demands as they advance value-based models of care," writes Cheryl Modica, Ph.D., MPH, BSN, Director of the Quality Center of the National Association of Community Health Centers (NACHC). Established in 1971, the NACHC serves as the national voice for America's Health Centers and as an advocate for health care access for the medically underserved and uninsured. The article appears as part of an upcoming JHQ Special Issue, devoted to the topic of 'Quality as a Business Strategy.'

'Actionable Pathway' to Improve Value via Infrastructure, Care Delivery, and People

In response to rising healthcare costs, demographic trends, and new technologies, the transition to value-based care is occurring throughout the healthcare system. "Value-based care reimburses providers based on quality of care, outcomes, and cost, as opposed to a fee-for-service model that reimburses based on the volume of services delivered," Dr. Modica explains.

But to date, there has been no clear, standardized, organizing framework that federally qualified health centers can use as an "actionable pathway" toward systemwide change to advance value. This important group of health centers provides care to approximately 28 million patients across the United States—largely low-income patients facing social and environmental risk factors.

The NACHC Quality Center developed the VTF model to support federally qualified health centers in making the transition to value-based care. The model seeks to guide systems change toward the "Quadruple Aim" goals of value-based care: improved healthcare outcomes, improved patient experience, improved staff experience, and reduced costs.

Based on evidence-based and promising practices, the VTF addresses three health center system domains: Infrastructure, Care Delivery, and People. Within each domain are five Change Areas, providing well-defined but flexible steps toward improvement. For each of the 15 Change Areas, the model provides concise, step-by-step instructions to advance health center transformation. The Action Guides can be found at http://www.nachc.org/clinical-matters/value-transformation-framework/

The VTF model was field-tested as part of a two-year Cancer Transformation Project funded by the Centers for Disease Control and Prevention (CDC). Evaluation found a 13.6 and 6.5 percentage-point increase in colorectal and cervical cancer screening rates respectively, during the first year. Further steps included feedback from health center stakeholders, leading to fine-tuning of the Change Areas and recommendations for further implementation. Initial results of VTF deployment in a national cohort of 115 health centers in 19 states will be available in 2020.

Although its intended audience is federally qualified health centers, "the steps and actions described in the VTF may also apply to other health care organizations and networks," Dr. Modica concludes. "If the VTF approach continues to demonstrate value, it can provide an actionable guide for systems change in advancing on the Quadruple Aim goals."

The Special Issue includes five additional papers illustrating the wide range of programs being implemented by interprofessional teams across the health continuum to improve the quality of care. "Few healthcare systems have the resources to do the important work to systematically develop innovative models of care resulting in improved quality and safety while maximizing reimbursement and decreasing associated cost of care," write Guest Editors Cathy E. Duquette, Ph.D., RN, NEA-BC, CPHQ, FNAHQ, and Nidia S. Williams, Ph.D., MBB, CPHQ, FNAHQ. "Despite the differences in healthcare settings and populations served, the future of healthcare value will be dependent on embracing quality as a business strategy."