NHA unveils system to rate the effectiveness of hospitals appointed under the AB PM-JAY scheme

A new methodology is being implemented by the National Health Authority (NHA) as part of the flagship programme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana to evaluate hospital performance (AB PM-JAY).

The new programme will introduce the idea of “value-based care,” where clinicians will be compensated based on the calibre of the care they offer and payment will be outcome-based. In the new system, healthcare professionals will be compensated for assisting patients in enhancing their health, which will ultimately lessen the long-term repercussions of disease on the populace.

The initiative is expected to be advantageous to all parties, including patients, healthcare professionals, payers, and suppliers, and it has the potential to greatly increase gains in overall health. Patients will have better health outcomes and higher levels of service satisfaction, while physicians will gain from more effective care delivery. Payers will also be able to maximise the improvements in health that result from their spending.

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The CEO of the National Health Authority, Dr. RS Sharma, discussed the programme and said, “NHA has created many processes to ensure PM-JAY participants receive both cashless healthcare benefits and high-quality care at every empanelled facility. New and innovative treatment modalities will be added, and the cost of care under the programme will be standardised.

Five performance indicators, including Beneficiary Satisfaction, Hospital Readmission Rate, The Amount of Out-of-Pocket Expenditure, Confirmed Grievances, and Improvement in Patient’s Health-Related Quality of Life, will be used to evaluate the performance of AB PM-JAY empanelled hospitals under value-based care.

The performance of the hospitals according to the aforementioned measures will also be made public on a dashboard to assist the beneficiaries in making educated decisions. In this way, the performance of the hospital would not only affect its financial incentive but will also increase beneficiary demand for high-quality care under PMJAY.

Together, the use of health technology assessment, performance evaluation, value-based incentives, and digital technologies to track the quality of service would change AB PM-JAY and the Indian health system from a volume-based to a value-based health care delivery system.