Value-Based Health Care in Ophthalmology

» Create one place to handle all ophthalmology care complexity, including surgeries and routine examinations.

» Select the most prevalent diseases to increase opportunities for efficiency and develop consistent cycles of care. Introduce an easy-to-use electronic medical record for collecting the most important outcomes metrics.

» Establish a system of collaborative clinical teams for physicians and well-trained supporting staff.

» When moving away from a volume-based system, establish a fair policy for physician compensation.

» Implement care practice guidelines for the medical team. Measure patients’ perception of care.

Efforts to determine the true costs of health care and then integrate cost-control measures as part of a strategy to deliver high-quality, value-based care remain a challenge to health care providers and managers. The Vera Cruz Ophthalmology clinic was launched by the Hospital Care Group, an integrated health system that includes the Vera Cruz Association, a health insurance company. A value-focused, single-site clinic in Campinas, Brazil, was designed to address major challenges regarding expenditures in ophthalmology. The concentration of all eye care in one integrated practice unit and the use of clinical guidelines allowed a reduction in the number of visits and examinations compared with the period before the launch. Standardized care using a customized electronic medical record platform allowed the evaluation of clinical outcomes. The implementation of this new model reduced the overall cost for the insurance company by 24.7%, with a Net Promoter Score of 94.

Reference: Ferrai PV, Goncalves FANI, De Maria PF, Herrerias BT, Gracitelli CPB, Hirai FE. How an Integrated Delivery System in Brazil Moved Toward Value-Based Health Care in Ophthalmology. NEJM Catalyst. February 2022. Accessed February 24, 2022. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0379