Question

A coordinator at a hospital that is developing its new value-based care approach is combing through files to identify patients who are vulnerable to high healthcare costs. Which of these patient factors is likely to be considered high-risk?

1) Age
2) Income
3) Chronic conditions
4) Insurance coverage

Answer 1

Chronic conditions are considered high-risk in identifying patients vulnerable to high healthcare costs. The balance of treatment costs, patient quality of life, and privacy risks, along with strategies to avoid insurance death spirals and integrating HMOs, are crucial considerations when developing value-based care policies.

Step-by-step explanation:

When identifying patients who are vulnerable to high healthcare costs, the coordinator at a hospital developing a value-based care approach would consider several different factors. Of the ones listed (age, income, chronic conditions, insurance coverage), chronic conditions are likely to be considered high-risk. Chronic conditions often require ongoing treatment and management, leading to higher healthcare costs over time. To address these concerns while developing policies, three critical questions include: How can the balance between costs of treatments and diagnoses, patient quality of life, and risks to individual privacy be maintained? What strategies can be implemented to avoid potential insurance death spirals as a result of adverse selection? How can value-based care accommodate not only fee-for-service systems but also incorporate Health Maintenance Organizations (HMOs) to reduce costs and improve patient outcomes?

Answer 2

The high-risk factor for healthcare costs from the given options is patients with chronic conditions. In the context of a value-based care approach, it is crucial to address questions about cost distribution, quality of life, and the protection of health records to ensure a sustainable and equitable healthcare system.

So, the correct answer is 3) Chronic conditions.

Step-by-step explanation:

When developing a value-based care approach and identifying high-risk patients vulnerable to high healthcare costs, one factor out of the four options that is likely to be considered high-risk would be patients with chronic conditions. Having chronic illnesses often requires ongoing treatment, complex management, and can lead to additional health complications, making care more expensive. Patients with chronic conditions are an essential consideration for hospitals when balancing the complex interplay of treatment costs, patient quality of life, and privacy risks.

In developing policies around these issues, three critical questions must be addressed:

1. How can we equitably distribute healthcare costs, ensuring those with chronic illnesses receive proper care without disproportionately inflating costs for all patients?
2. What strategies can improve the quality of life for patients while still maintaining cost-effective healthcare practices?
3. How can patient privacy be protected while still allowing for the necessary flow of health records and information to provide optimal care?

These questions highlight the need for careful policy development that considers the adverse selection effect, where those with higher risks are more likely to seek insurance, potentially leading to increased premiums for all. It also touches upon the importance of avoiding a situation that would cause healthy individuals to leave the insurance pool, which could result in an insurance death spiral, heavily burdening the system with the costs of care for those with chronic conditions.

So, the correct answer is 3) Chronic conditions.