Understanding Value-Based Care in Healthcare: A New Paradigm

Hello, A lot of changes are being made in the healthcare sector and one of such is a paradigm shift from a volume- based payment plan (fee for service) to a value- based payment plan (fee for value /quality of service). A volume-based reimbursement plan refers to the payment received by a health care provider for services

rendered to a patient in which the type or quality of service does not determine the amount the provider receives. The volume- based care accounts for why healthcare providers rush through patients so as to attend to many patients without giving the best care possible because the more

patients they attend to, the more money they will receive and made them focus on speed (so as to attend to a large number of patients) as a measure of success rather than the quality of service they offered. The value-based payment plan on the other hand focuses on the quality care rendered at the

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lowest cost to patients. A shift to value-based care was necessary so as to ensure that patients get the best of care at a lowest cost. The model I have selected is the Comprehensive ESRD Care Model. “The Comprehensive ESRD Care (CEC) Model is designed to identify, test, and evaluate new ways

to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD)” (CMS.gov, 2020). CMS established the Comprehensive ESRD Care model to test a new system of payment and care delivery that will lead to better health outcomes for Medicare beneficiaries living with ESRD, while lowering

costs to Medicare Parts A and B. CMS through the CEC Model is expected to partner with health care providers and suppliers to test how effective this new model will be in providing beneficiaries with person- centered, high- quality care. The Model builds on Accountable Care Organization experience from the

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Pioneer ACO Model, Next Generation ACO Model, and the Medicare Shared Savs 5-2 Final Project Part B Milestone Two: Interview Transcript Outline Michelle Beste ATH-101 Prof Busby February 9, 2024

I. Cultural Diversity A. Reporter: What is so important that we understand cultural diversity in a time like this? Who cares if we’re all different? What does it matter anyway? i. Your response: Understanding cultural diversity helps dissipate negative stereotypes and personal biases about different groups, cultures, religions, and values. Cultural diversity helps us recognize and respect ways of life and being that are not necessarily our own and offers an opportunity for inclusiveness. In terms of human sociocultural identity related to gender a lot of people think of doctors as male and nurses as female. ii. Your response: Regarding human behavior and how it relates to sociocultural identity, mother are often thought to be the loving, nurturing, gentle parent. In contrast the father is often thought of as strict and the provider. iii. Your response: An example of human sociocultural identity related to animals would be when people think of lions, they think of a pride. Although male and female lions have different roles in the wild both are symbols of pride and strength. B. Reporter: Human culture might seem more complex than I initially imagined, so how does it relate to the crisis we’ve witnessed here? i. Your response: Regarding crisis situations, such as the right to fail, anthropologists can help us create a holistic approach to mental health, giving us the capability to put the individual at the core of their treatment. They can do this by helping us understand how different cultures recognize mental illness. In eastern nations treating someone with a mental illness should be done in a social way versus western nations that support institution care. In order to better understand and decide how to help people with mental illness in our society, we must concentrate on an anthropological perspective. In doing so, we are able to view each person as a whole, not just by their condition or symptom.

II. Anthropological Methods: A. Reporter: Alright, can you explain to the audience how you came to this conclusion? i. Your response: Clinical ethnography has been shown to have value in addressing systemic as well as individual care needs for diverse communities. By gathering knowledge about cultural heritage, health beliefs and biographies we can gain a deeper understanding to improve the care offered, adapting it as needed, to the context of the patient. Clinical ethnography also gives the patient a voice in the consultation, engendering trust, motivating help-seeking, and improving the quality of care, engagement, and outcomes for culturally diverse patients with mental illness. Studies show the approach leads to better diagnosis and treatment, improved outcomes in psychosis, as well as better outcomes in psychotherapy for depression. B. Reporter: How did these people let you study them? Why did they let you? You most likely upset them, right? i. Your response: When working with people that are mentally ill there is a certain level on unpredictability that you have to be aware of. Most of these people are used to be disregarded and unheard. By using the approach, I just discussed the patient has a voice and you are able to build trust. As someone that has direct experience with mental illness and the impact that it can have when untreated I am able to approach these individuals with a level of empathy and compassion they may not have had before. ii. Your response: Objectivity is closely related to the concept of cultural relativism, in that its primary goal is to remain free of bias. By being objective, we present an approach those shows that we are not passing judgment or making any predetermined decisions. It shows that we are solely there to focus on helping them with their current crisis. III. Cultural Connections: A. Reporter: Do you think this crisis could happen here, to us? i. Your response: Absolutely. Mental illness is a universal condition that knows no age, sex, gender or race and is very common in the US. According to the CDC 1 in 5 US adults, nearly 50 million Americans, live with a mental illness. And that is only the people that we know about. That does not include those that can’t afford health insurance or medical care so they have not received the appropriate diagnosis or treatment. ii. Your response: Things like genetics, fetal damage, substance abuse during pregnancy, exposure to toxins all contribute to allowing this crisis to occur.

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iii. Your response: Poverty, homelessness, family abuse, substance use are just a few of many components that can contribute to this crisis occurring. IV. Predictions: A. Reporter: Do you think there is anything that could have informed these people of the crisis? I would hate to think that this could have been recognized and prevented earlier. i. Your response: As I mentioned before, mental illness does not discriminate so there is no real way to know who will develop mental illness at some point in their life. Family history may help us determine the likelihood of someone developing a genetic mental illness but because lifestyle choices and environment can have such an impact even that can’t say with certainty. B. Reporter: Now, I can bet there are people at home that are scared. So, how can you, as an anthropologist, help in preventing this crisis from happening to us? i. Your response: We can produce qualifications and awareness for professionals so that they can implement relevant theories and methods to approach the crisis and the public. By having an understanding of the demographic, we can assist on how to communicate a public health message in a way that respects and aligns with local beliefs and practices. C. Reporter: Finally, do you still enjoy being an anthropologist throughout this apparent chaos? I mean, how has being an anthropologist helped you out personally? i. Your response: This line of work is very rewarding and working with this crisis has been very fulfilling. I get to see the evidence that I gather help improve the future for others and our society as a whole. I have learned a lot about my own mental illness and the empathy needed to work with this population.

References Clinical ethnography in severe mental illness: a clinical method to tackle social determinants and structural racism in personalised care https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086386/ About Mental Health https://www.cdc.gov/mentalhealth/learn/index.htm#:~:text=More%20than%201%20in%205,a %20seriously%20debilitating%20mental%20illness.&text=About%201%20in %2025%20U.S.,bipolar%20disorder%2C%20or%20major%20depression . Why Psychiatry Needs the Anthropologist: A Reflection on 80 Years of Culture in Mental Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777847/ How anthropological theory and methods can advance global mental health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957809/

5-2 Interview Outline (1)

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