Value-based health care: Connecting the dots

Jan. 17, 2020 / By Felisha Bochantin

The 34^th Annual Patient Classification System International (PCSI) Conference was co-hosted by the Danish Health Data Authority, Nordic Casemix Centre and the Danish Regions organization. I attended it with two of my colleagues, 3M U.S. representatives Dr. Marc Berlinguet and Meegan Snell of 3M Australia. The PCSI Conference has been a staple for coding classifications, and it’s the keynote case-mix event where researchers, data analysts and other healthcare professional discuss the current state of case-mix based classifications and systems, as well as healthcare funding and its future. PCSI is the only worldwide organization addressing case-mix issues. In the last few years, the annual international conference has brought together a growing number of active participants from all over the world.

Areas of interest at the conference this time around included global industry standards of activity-based, value-based health care and patient safety quality efforts. Another focus was on how to shape the world into adopting unified healthcare changes in a more cohesive manner.

During the daily workshops, my colleagues and I presented on the adaptation of Potentially Preventable Readmissions with concentration on the case use of the PPR Grouper within Australia’s coding classification and on the Potentially Preventable Readmissions Analyses Uses and Potential Misuses, where examples from Minnesota’s Reducing Avoidable Readmissions Effectively (RARE) Campaign were presented showing a calculated reduction of approximately 7,000 readmissions over two and a half years. This campaign won the John M. Eisenberg Patient Safety and Quality award in 2013 and serves as an ideal model for improved outcomes in Australia.

Meanwhile, ICD-11 is looming in the background and starting to gain momentum. The concept of national modifications is undecided. 2022 is when ICD-11 will be introduced for mortality reporting, with an agreed transition period of five years for mortality coding.  Implementation dates for morbidity coding are not yet set by individual countries, however it appears that projects and discussions are starting to ramp up. It was revealed at the conference that some African nations will start using ICD-11 as their national reporting classification.  

In closing, here are a few current and future challenges we should keep in mind: The global population is getting older and more people are suffering from chronic illnesses and multi-morbidities. There is pressure on the taxing and financing system, more expensive treatments, new technologies and higher expectations of the patient. Patient data linkage and corresponding legislation is a major roadblock to measuring the health of individuals across the healthcare spectrum and requires the attention of many governments. The Danish Healthcare system, for example, has reported a major transition in the past 10-20 years, where the DRG system and activity-based funding have been useful for increasing productivity and reducing patient wait times. There is a definite global trend toward employing more quality-focused payment methodologies and more robust classifications to better monitor, control and incentivize the performance and efficiency of healthcare services across the care continuum.

Felisha Bochantin is an International Population Health Clinical Analyst with 3M Health Information Systems.