Training Course on Value-Based Care and Payment Models

Module 1: Foundations of Value-Based Care
Subtopics:
Historical evolution: fee-for-service → managed care → value-based care.
Key definitions: value, quality, outcomes, efficiency.
The Triple Aim (better care, better health, lower costs) and the Quadruple Aim (adding provider well-being).
Role of patient-centered care in VBC.
Contrasting incentives: volume vs. value.
Activities/Examples:
Case Example: Comparison of knee replacement care under fee-for-service vs. bundled payments.
Reflection Exercise: Participants map out inefficiencies in their local healthcare system and identify where VBC could improve outcomes.

Module 2: Payment Models in Value-Based Care
Subtopics:
Review of traditional models: fee-for-service, DRGs.
Value-based alternatives:
Pay-for-performance (quality incentives).
Bundled payments for episodes of care.
Capitation (population-based payment).
Shared savings and shared risk arrangements.
Balancing incentives for providers, payers, and patients.
Equity and access considerations in payment design.
Activities/Examples:
Group Simulation: Design a bundled payment for managing diabetes (covering consultations, labs, medication, and complications).
Debate: Capitation vs. shared savings — which model works best for primary care?

Module 3: Data, Measurement, and Quality Metrics
Subtopics:
Importance of data for measuring value.
Clinical quality measures (CQMs): safety, effectiveness, efficiency.
Patient-reported outcome measures (PROMs).
Using QALYs (Quality-Adjusted Life Years) in evaluating value.
Risk adjustment to ensure fair comparisons across providers.
Role of digital tools: EMRs, dashboards, predictive analytics.
Activities/Examples:
Workshop: Build a sample outcomes dashboard for hypertension management (using predesigned datasets).
Exercise: Identify appropriate outcome metrics for a mental health program.
Case Review: How Kaiser Permanente uses data-driven care for value-based outcomes.

Module 4: Implementation of Value-Based Care Models
Subtopics:
Steps for transitioning from volume to value-based systems.
Aligning provider incentives with payer objectives.
Building multi-stakeholder collaborations (patients, providers, insurers, policymakers).
Managing provider resistance and cultural change.
Legal and regulatory considerations in different countries.
Financial risks for providers: up-front costs, cash-flow issues.
Strategies for scaling VBC pilots.
Activities/Examples:
Case Study: Establishing an Accountable Care Organization (ACO) in the U.S. and lessons for LMICs.
Role Play: Stakeholder negotiation — hospital administrator vs. insurance company vs. patient advocacy group.
Action Planning: Participants outline the steps to launch a pilot VBC project in their institution.

Module 5: Global Trends and Future of Value-Based Care
Subtopics:
Global adoption trends: U.S. Medicare/Medicaid reforms, NHS initiatives in the UK, Netherlands bundled care, Singapore’s population health model.
Opportunities and challenges in low- and middle-income countries.
Digital transformation: role of telehealth, wearables, and AI.
Predictive analytics for risk-based contracting.
Future hybrid models: blending fee-for-service with value-based incentives.
VBC and health equity — ensuring inclusion of underserved populations.
Activities/Examples:
Capstone Project: Design a value-based payment model for a chronic disease program (e.g., hypertension, HIV, cancer, or maternal health).
Panel Discussion: Emerging technologies (AI, big data) and their role in shaping the future of VBC.
Group Presentation: Teams propose a roadmap for adopting VBC in their home country or institution.