NEW DELHI: The National Health Authority (NHA) is introducing a new system to measure and grade hospital performance under the flagship programme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana with a view to shifting the focus of measuring hospital performance from volume of services provided to the value of healthcare services (AB PM-JAY).

From the payer's standpoint, the healthcare system has traditionally placed a premium on the volume of services rendered, with case-based bundled payments depending on the number of services rendered.

According to officials, the new programme will introduce the idea of "value-based care," where providers will be compensated based on the effectiveness of the care they offer and payment will be outcome-based. In the new system, healthcare professionals will be compensated for assisting patients in enhancing their health, which consequently will reduce the effects of disease in the population in the long term.

The action is expected to benefit all parties, including patients, healthcare providers, payers, and suppliers, and it promises to significantly boost total health gains. Patients will have improved health outcomes and increased levels of service satisfaction, while providers will benefit from improved care efficiencies. The payers will also be able to maximise the health benefits brought about by their expenditures, official said.

R.S. Sharma, CEO of the National Health Authority, spoke about the project and said, "NHA has put in place a number of mechanisms to guarantee that PM-JAY users receive both cashless healthcare benefits and high-quality care at every empanelled facility. The cost of care under the programme will be standardised, and new and cutting-edge treatment techniques will be added. The NHA has also included a clause to reward top-performing hospitals for giving patients high-quality care." The payers also have strict cost constraints in a value-based healthcare system. Officials mentioned that a healthier population with fewer claims translates into less drain on payers' premium pools and investments

Being able to link their goods and services with improved patient outcomes and lower costs would be advantageous for suppliers. Value-based care will encourage and incentivize healthcare providers to concentrate more on providing patient-centric services, which has the potential to greatly improve the healthcare system in India.

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