The Value Transformation Framework: An Approach to Value-Based Care in Federally Qualified Health Centers.

BACKGROUND: With the transition toward value-based care, health care organizations have a business imperative to simultaneously focus on improved health outcomes, improved patient and staff experience, and reduced costs (the Quadruple Aim). For federally qualified health centers-which provide care to some of nation's most vulnerable populations-balancing the complex task of systems change in the face of overwhelming volumes of information and best practices is challenging and can be supported through a guiding framework. PURPOSE: This need for synthesis and translation of evidence in an actionable and practical way led to the design of a model for health center systems change. This article describes the development process and defines the resulting conceptual framework. METHODS: Deployed a four-step process between 2016 and 2018 to develop and test a framework for value transformation in health centers. RESULTS: NACHC's Quality Center developed the Value Transformation Framework to guide health center systems change toward high value care. The framework identifies 15 change areas across three Domains: infrastructure, care delivery, and people and summarizes evidence-based action steps within the change areas. CONCLUSIONS: The framework shows promise in supporting health center efforts to adapt, transform, and balance competing demands as they advance value-based models of care.

Efficiency of federal hospitals in the United States.

This study evaluates the technical efficiency of federal hospitals in the United States using a variable returns to scale, input-oriented, data envelopment analysis (DEA) methodology. Hospital executives, health care policy-makers, taxpayers, and other stakeholders, benefit from studies that improve the efficiency of federal hospitals. Data for 280 federal hospitals in 1998 and 245 in 2001 were analyzed using DEA to measure hospital efficiency. Results indicate overall efficiency in federal hospitals improved from 68% in 1998 to 79% in 2001. However, based upon 2001 spending of $42.5 billion for federal hospitals potential savings of $2.0 billion annually are possible through more efficient management of resources. From a policy perspective, this study highlights the importance of establishing more specific policies to address inefficiency in the federal health care industry.

Effects of restricting levothyroxine dosage strength availability.

We conducted a prospective, randomized, controlled trial to assess whether hospital formulary restrictions involving limiting dosage strengths of levothyroxine affect physicians' ability to manage patients effectively and provide pharmacy cost savings in a tertiary care federal government research hospital. Thirty-three endocrinologists were randomly assigned to prescribe levothyroxine from a restrictive (dosage strengths of 25, 50, 100, 125, and 150 micrograms) or a nonrestrictive (dosage strengths of 25, 50, 75, 100, 112, 125, 150, 175, 200, and 300 micrograms) formulary through a central computer system. Their 241 respective outpatients' laboratory results and drug compliance were outcome measures. Achievement of treatment objectives was measured by thyroid function tests (free and total thyroxine, total triiodothyronine, thyrotropin), number of clinic visits, and compliance (survey method). Additional measures were drug distribution patterns, drug costs, and pharmacy inventory costs. Restriction of levothyroxine's dosage strength did not significantly alter therapeutic outcomes. However, the restricted formulary was associated with more complex dosing regimens, and resulted in no significant cost savings. It is not known whether such restriction would adversely affect the care of patients of nonspecialists. Prospective studies are required to verify presumed cost-containment measures before such measures are adopted for widespread application.

Cost containment of reconstituted parenteral antibiotics: personnel and supply costs associated with preparation, dispensing, and administration.

Time-and-motion studies were conducted to determine the time and cost associated with the dispensing, preparation, and administration of reconstituted parenteral antibiotics via the piggyback iv admixture (PBS) or volume control iv set administration (VCS) methods in six hospitals of various sizes. Supply costs were calculated for each system. National projections of potential cost savings resulting from decreased number of administrations of reconstituted parenteral antibiotics were made. The antibiotic class of parenteral cephalosporins was chosen as an example of where cost containment might be achieved. The estimated potential for total cost containment for the average hospital per hospital bed resulting from decreased number of administrations of first- and second-generation cephalosporins ranged from $76.64 (25% reduction in doses administered) to $229.92 (75% reduction) for the PBS method and, similarly, $47.02 to $141.08 for the VCS method. The projected potential national cost savings resulting from decreased number of administrations of first- and second-generation cephalosporins based on predicted antibiotic usage for 1983 ranged from $62.2 million (25% reduction in doses administered and adjusting for no conversion to intramuscular or intravenous push administrations) to $276.7 million (75% reduction). Clinicians and health-care managers should consider the cost-containment advantages provided by the substitution of newer antibiotics that permit reduced frequency of administration.