What is Value-Based Care?

Value-based healthcare is a healthcare delivery model in which providers are paid based on patient health outcomes. Under a value-based care system, providers are rewarded for helping patients improve their health, reduce chronic disease, and live healthier lives in an evidence-based way.

In contrast, in a fee-for-service model, providers are paid based on the amount of healthcare services they deliver. This can promote increases in the quantity of services, and providers are incentivized to order more tests and procedures and manage more patients in order to get paid more, regardless of patient outcomes.

20% of Medicare payments in 2015 were made through a value-based model

Health and Human Services

Last year, Health and Human Services (HHS) announced that 20 percent of Medicare payments in 2015 were made through a value-based model. In the same announcement, HHS also reported that ACO programs had saved $417 million for Medicare and value-based payment models helped reduce hospital readmissions in Medicare beneficiaries by eight percent.

What Value Based Care Models are Available?

As value-based care has grown, so too have the variety of value-based care models used today. A few examples of value-based care models:

Accountable Care Organizations

Accountable care organizations (ACOs) were originally designed to provide high-quality medical care to Medicare patients. In an ACO, doctors, hospitals, and other healthcare providers work as a team to deliver the best possible coordinated care at the lowest possible cost. Each member of the team is incentivised to improve access to care, quality of care, and patient health outcomes while reducing costs.

Patient-centered Medical Homes

In a patient-centered medical home (PCMH), primary, specialty, and acute care are integrated. A medical home isn’t a physical location. Instead, it’s a coordinated approach to patient care, led by a patient’s primary physician who directs a patient’s total clinical care team.

PCMHs rely on the sharing of electronic medical records (EMRs) among all providers on the coordinated care team. The goal of EMRs is to allow the team to easily see the results of tests and procedures performed by others on the team. This data sharing has the potential to reduce redundant care and associated costs.

Bundled Payments

A Bundled payment is a single payment for services provided for an entire episode of care. Providers are collectively reimbursed for the expected costs to treat a specific condition that may include several physicians, settings of care, and procedures. For example, if a patient undergoes surgery, the practice would combine the set payment to the hospital, surgeon, and anesthesiologist, rather than paying each separately. The bundled payment is determined on historical prices.

What Are The Benefits of Value Based Care ?

Managing a chronic disease or condition like cancer, diabetes, or obesity can be costly and time-consuming for patients. Value-based care models focus on helping patients recover from illnesses and injuries more quickly and avoid chronic disease in the first place. As a result, patients face fewer doctor’s visits, medical tests, and procedures, and they spend less money on prescription medication as both near-term and long-term health improve.

In a country where healthcare expenditures account for nearly 18% of Gross Domestic Product (GDP), value-based care has the promise to significantly reduce overall healthcare costs.

As a whole, populations also benefit from value based care systems because less money is spent helping people manage chronic diseases and costly hospitalizations and medical emergencies. In a country where healthcare expenditures account for nearly 18% of Gross Domestic Product (GDP), value-based care has the promise to significantly reduce overall healthcare costs.

Benefits for Providers

Providers benefit from value based care, because they are able to focus less on chronic disease management and more on prevention-based services. In addition, providers don’t have the same financial risk that comes with fee for service systems.

Benefits for Payers

Payers benefit from value based care systems because risk is reduced by spreading it across a larger patient population. A healthier population with fewer claims means less drain on payers’ premium pools and investments. Value-based payment also increases efficiency for payers by bundling payments that cover the patient’s full care cycle.

Benefits for Suppliers

Suppliers benefit from being able to align their products and services with positive patient outcomes and reduced cost, an important selling proposition as national health expenditures on prescription drugs continue to rise. Many healthcare industry stakeholders are calling for manufacturers to tie the prices of drugs to their actual value to patients, a process that is likely to become easier with the growth of individualized therapies.

What is The Future of Value Based Care?

The successful transition from a fee for service to value based care will not be a short journey, but based on measurable results taken so far, a value based system will end up lowering healthcare costs in the long run by putting preventative measures first.

In busy clinics, resources are limited, which puts an extra onus on technology to do more of the heavy lifting. Physicians and practice managers will see benefits from the “no touch, low touch solutions” that help drive automation and lead to optimized workflows and a notable reduction in workloads.

Value-based Care Analytics & Quatris Healthco

Having clear visibility into both clinical and financial data is key to the success of a practice. That’s why we offer a suite of value-based care solutions and reporting products to give the valuable insight you need in a value-based care environment. With our value-based care services, your practice can:

Enhance Care Quality

With advanced value-based care analytics it’s easier to identify high-risk patients and gaps in patient care – by synthesizing data from previous visits and other care settings into one view, you get a more complete picture of patient health. Helpful tools like a pre-visit planner and a missed opportunities dashboard also ensure that more time is spent on critical elements during the patient visit.

Improve Provider Efficiency

Providers can reduce time spent searching for information and access data from previous patient visits, claims, and other care settings in one view. On top of this, the pre-visit planning tool can help providers adjust schedule and staff around the complexity of each patient visit.

Strengthen Financial Performance

Value-based care analytics can easily identify patients with care gaps for outreach to drive up care quality and ensure patients receive needed service. Value-based care analytics also help providers understand which services patients utilize out of network and take steps to reduce leakage.

Clear the path to payment

Value-based reimbursements are calculated by using numerous measures of quality in determining the overall health of populations. Unlike the traditional model, value-based care is driven by data because providers must report to payers on specific metrics and demonstrate improvement. Providers may have to track and report on hospital readmissions, adverse events, population health, patient engagement, and more.