Outside the Hospital Walls: Associations of Value Based Care Metrics and Community Health Factors

Abstract

As the healthcare industry shifts from traditional fee-for-service payment to value-based care models, the need to accurately quantify and compare the performance of institutions has become an integral component of both policy and research. To date, several notable metrics have been introduced, including the Centers for Medicare and Medicaids Hospital Value Based Purchasing (HVBP) program. However, despite widespread adoption, these standards suffer from a fundamental oversight. Where the factors utilized to characterize performance reflect only intrinsic facets of an institutions care, capturing elements of mortality rates, patient satisfaction, outcomes, and spending. Yet, this approach is directly at odds with our current understanding of health and wellness, as it is well known that social, economic, and community factors are deeply intertwined with healthcare outcomes. To this end, with institutions spread across diverse geographic regions, our manuscript demonstrates that HVBP performance metrics do not exist in isolation. Rather, they possess strong associations to the community factors in which the institution resides. Aggregating a broad set of factors from disparate data sources, this work moves through the informatics pipeline. Identifying performance scoring profiles though clustering and employing robust linear models to uncover novel relationships and advance the discussion around the need for value-based care quality metrics.