Last updated on June 28th, 2023 at 05:17 pm
The National Health Authority (NHA) is introducing a new system to measure and grade hospital performance under the flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in order to shift the focus of measuring the performance of hospitals from the volume of services provided to the value of healthcare services.
Traditionally, the healthcare model has been focused on the number of services delivered from the payer’s perspective, where case-based bundled payment is made on the basis of the number of services provided.
The new initiative will introduce the concept of ‘value-based care,’ where providers will be paid based on the quality of care they deliver. The new model will reward providers for helping patients improve their health, which will reduce the effects of the disease on the population in the long term.
This step is expected to be a win-win for all concerned stakeholders from patients to healthcare providers, payers, and suppliers by promising a significant increase in overall health gains. Providers stand to get better care efficiencies out of the services while the patients will get better health outcomes and higher satisfaction. Payers will be able to maximize health benefits and minimize spending.
Speaking on the initiative Dr. R.S. Sharma, CEO of, the National Health Authority, said, “NHA has implemented various measures to ensure that the beneficiaries of PM-JAY get both cashless health benefits and high-quality care at each empaneled hospital.
These measures include standardization of the cost of treatment and the introduction of new and advanced treatment procedures under the scheme. Additionally, the NHA has made provisions to incentivize the best-performing hospitals to provide quality care to the patients.”
Under a value-based healthcare system, payers would have stronger cost controls. A healthier population results in fewer claims and less drain on payers’ premium pools and investments. If suppliers were able to align their products and services with positive patient outcomes and reduced costs, it would benefit them. Value-based care has the potential to significantly improve healthcare in India by incentivizing providers to focus on delivering patient-centric services.
Under Value-Based Care, the performance of the AB PM-JAY empaneled hospitals will be measured on the basis of five performance indicators:
- Beneficiary satisfaction;
- Hospitalization Rates
- Limit on out-of-pocket expenditure;
- Confirmed Grievance and
- Improving the quality of life-related to the patient’s health.
A public dashboard that will help the beneficiaries to make an informed decision will also make the performance of the hospitals based on the above indicators available. This way, not only will the hospital’s performance determine the financial incentive the hospital receives, but it will also create a demand for quality treatment of beneficiaries under PMJAY.
From a volume-based to a value-based healthcare delivery system, these interventions of performance assessment and value-based incentives, use of health technology assessment, and use of digital tools to monitor AB PM-JAY will transform the Indian healthcare system with higher quality care.
