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73 Executive Briefing: Everything Old is New Again and Vice Versa: Three Considerations for Assessing the Value of Achieving Quality and Value in Hospital Services By: Andrea Ferrari, JD, MPH, Healthcare Appraisers, Inc. A mong hospitals, new Medicare and other payer policies have focused attention on measures of "quality" and "value." Among some, the new focus on quality and value is viewed as the steam engine for transformation and innovation in relationships with physicians and other provid- ers. Among others, it is viewed as a change in the language of business, giving new names and life to old ideas and strategies that, for one reason or another, fell out of favor previously but have returned to the limelight in a cyclical fashion. Although the extent to which ideas are new or old may be debatable, one effect of assimilating quality and value into the lexicon of hospital operators has been clear: An increase in transactional activity that is focused on securing alignment, collaboration and clinical integration with physicians. The universe and variations of clinically-integrated net- works, accountable care organizations, hospital-physician co-management arrangements, hospital-physician shared savings arrangements, gainsharing arrangements and other types of quality and value-focused ventures is expanding and Table 1: Examples of Common Alignment Strategies for Achieving Quality and Value 1 1 This table is adapted from one that was presented in a webinar presentation that the author performed with others for Strafford Publications. Sponsored by: Everything Old is New Again and Vice Versa: Three Considerations for Assessing the Value of Achieving Quality and Value in Hospital Services By: Andrea Ferrari, JD, MPH, Healthcare Appraisers, Inc. Among hospitals, new Medicare and other payer policies have focused attention on measures of "quality" and "value." Among some, the new focus on quality and value is viewed as the steam engine for transformation and innovation in relationships with physicians and other providers. Among others, it is viewed as a change in the language of business, giving new names and life to old ideas and strategies that, for one reason or another, fell out of favor previously but have returned to the limelight in a cyclical fashion. Although the extent to which ideas are new or old may be debatable, one effect of assimilating quality and value into the lexicon of hospital operators has been clear: An increase in transactional activity that is focused on securing alignment, collaboration and clinical integration with physicians. The universe and variations of clinicallyintegrated networks, accountable care organizations, hospitalphysician comanagement arrangements, hospitalphysician shared savings arrangements, gainsharing arrangements and other types of quality and valuefocused ventures is expanding and evolving, as are questions about how such ventures should be structured and implemented. As is the case in nearly every industry and circumstance, the most complex and hotly debated questions relate to the flow of money — who will receive remuneration for what under which circumstances. Table 1 Examples of Common Alignment Strategies for Achieving Quality and Value 1 1 This table is adapted from one that was presented in a webinar presentation that the author performed with others for Strafford Publications. Everything Old is New Again and Vice Versa