Resource Library-Quality Review and Accountability: Building Value into Healthcare

Video Transcription

Video Summary

Mary Wright Cooper of Jefferson’s College of Population Health presents on the NACU competency domain of quality review and accountability, focusing on “building value” into healthcare. She defines value-based healthcare as improving patient outcomes relative to cost and explains how this idea grew from the Triple Aim and Porter/Teisberg’s work. She reviews why value-based care gained traction: rapidly rising national healthcare spending, a growing share of GDP devoted to healthcare, and concerns that outcomes (including recent declines in U.S. life expectancy) do not match the investment—especially compared with other OECD countries.<br /><br />Cooper outlines key payment models: traditional fee-for-service (still dominant), accountable care organizations (ACOs) and shared-savings arrangements, patient-centered medical homes, and bundled payments. She describes hospital pay-for-performance programs—Value-Based Purchasing, Readmissions Reduction, and Hospital-Acquired Conditions—and notes evidence showing minimal overall impact on quality and safety despite high administrative costs.<br /><br />She highlights measurement infrastructure shifts (CMS moving from the National Quality Forum to Battelle’s Partnership for Quality Measurement) and emphasizes challenges in measurement validity, especially for emerging social determinants of health metrics. Using maternal mortality and disparities as an example, she argues current metrics often miss what matters (e.g., respectful, safe environments and equity), limiting improvement. She concludes that quality professionals must understand value-based payment and measurement because economics increasingly drives healthcare decisions, even as effectiveness remains contested.

Asset Caption

Speaker: Mary Reich Cooper, M.D., J.D.

The United States continues on its journey toward value-based care, and the NAHQ domain of Quality Review and Accountability supports the premise that value is equal to outcomes over cost. Review the concepts and the organizations around value-based care, and discuss the association between quality metrics and payment. See how desired outcomes don’t always align with what we are measuring.

Meta Tag

Competency Tag QRA1

Competency Tag Description Relate payment models and the impact of healthcare quality, safety, and patient experience initiatives to organizational reimbursement.

Domain Tag Quality Review and Accountability

Keywords

value-based healthcare

quality review and accountability

Triple Aim

Porter and Teisberg

healthcare spending and GDP

accountable care organizations (ACOs)

bundled payments

hospital pay-for-performance programs

social determinants of health measurement