India's insurance scheme shifts to value-based care performance measure

India's insurance scheme shifts to value-based care performance measure Adam Ang

The National Health Authority of India will now incentivise hospitals for providing valuable service through a new initiative.

Under the flagship insurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana or AB PM-JAY, the agency will now shift its focus from the number or volume of services provided to the value of services to measure and grade healthcare providers' performances.

According to a press release, AB PM-JAY-linked hospitals will be paid and rewarded based on five performance indicators:

Beneficiary satisfaction

Hospital readmission rate

Extent of out-of-pocket expenditure,

Confirmed grievances

Improvement in patient's health-related quality of life

Not only will a hospital's performance determine its financial incentive but it will also create a demand for quality treatment among patient beneficiaries, the NHA noted.

Their performance grades will be made available on public dashboards to help AB PM-JAY beneficiaries make informed decisions.

WHY IT MATTERS

The NHA seeks to introduce the concept of value-based care across the Indian public health ecosystem. It believes that the shift to a new performance assessment and incentives measure, along with the use of health technology assessment and digital tools for monitoring care quality, will help move the AB PM-JAY scheme and the entire Indian health system towards a value-based healthcare delivery system.

That shift, it added, will lead to a "significant increase" in overall health gains and is expected to be a "win-win" for all stakeholders. "While the patients will get better health outcomes and higher satisfaction out of the services they receive, providers stand to get better care efficiencies. Similarly, payers will be able to maximise the health benefits generated out of the spending incurred," the NHA explained.

The agency further said that in a value-based system, payers can also exercise strong cost controls, resulting in a lesser drain on their premium pools and investments. Suppliers too would benefit from being able to align their products and services with positive patient outcomes and reduced costs.

THE LARGER TREND

The NHA has implemented various measures to ensure that AB PM-JAY beneficiaries are receiving both cashless healthcare benefits and high-quality care at partner hospitals. Recently, it standardised the cost of treatment and added new and advanced treatment procedures covered by the insurance scheme.

In other related news, the agency announced last week that it will be providing incentives of up to Rs 40 million (nearly $500,000) to health facilities and digital solutions providers who are promoting the creation of Ayushman Bharat Health Accounts. It is one of its latest efforts to accelerate digital health transactions across India under the Ayushman Bharat Digital Mission, a government programme that is building the country's digital health ecosystem.