Value-Based Care

National Health Authority (NHA) has introduced a new system under Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (AB PM-JAY). The new system is called Value-Based Care.

What is Vause-Based Care?

• It is a system introduced by NHA to measure and grade the performance of hospitals empaneled under Ayushman Bharat PM-JAY Scheme.
• This new system’s objective is to shift the focus from measuring the performance of hospitals from the volume of services provided to the value of healthcare services.
• In medical terms, Value-Based Care is defined as a healthcare delivery system in which providers, including hospitals and physicians, are paid based on patient health outcomes.

Five Performance Indicators for Empaneled Hospitals

1. Beneficiary Satisfaction;
2. Hospital Readmission Rate;
3. Extent of Out-of-Pocket expenditure;
4. Confirmed Grievances Redressal;
5. Improvement in-patients Health-Related Quality of Life.

Significance of Value-Based Care

• It will incentivize and encourage healthcare providers to focus on delivering patient-specific services and hence improve the overall health landscape in India.
• The patient will get better health outcomes and higher satisfaction out of the health services they received.
• Healthcare services providers stand to get better care efficiency.
• The payers will be able to maximize the healthcare benefits generated out of spending incurred.

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Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (AB-PMJAY)

• On 23rd September 2018, Prime Minister launched the AB-PMJAY scheme to provide accessible and affordable healthcare to the common man.
• It is a visionary step towards promotive, preventive, curative, palliative, and rehabilitative aspects of Universal Health Care (UHC).
• It is the world’s largest government-funded healthcare insurance program.

Benefits of AB-PMJAY

• It provides insurance coverage of up to ₹ 5 lakhs per family per year for secondary and tertiary care hospitalization.
• It covers 10.74 crore vulnerable families (approximately 50 crore beneficiaries, helping to reduce out-of-pocket expenditure.
• PMJAY provides paperless and cashless access to health services.

Key Features of AB-PMJAY

It comprises two interrelated components.

1. Creation of 1,50,000 Health and Wellness Centres (HWCs) at the primary level.
2. Pradhan Mantri Jan Arogya Yojna (PMJAY) which provides health insurance coverage to poor and vulnerable families for secondary and tertiary care.

Pradhan Mantri Aarogya Mitras (PMAM)

PMAM is creating a cadre of certified frontline healthcare professionals who will be the primary point of facilitation for the AB-PMJAY beneficiaries to avail treatment at the hospital and thus, act as a support system to streamline health services delivery.