Value-based care and value-based reimbursement are really starting to gain traction in the healthcare industry. While some providers remain reluctant to change the way they bill for care most are realizing value-based care is here to stay and are making the appropriate preparations. Rather than billing for the number of appointments and/or procedures conducted with FFS (Fee-For-Service) providers are receiving payments based on the value of care they deliver. Despite all of the uncertainties on how the federal government’s final policy will look, healthcare systems continue to adopt new payment and delivery methods.
While value-based care might seem like a relatively new principle in healthcare it has actually been around since the early 2000’s. Initially this payment method was used by companies to incentivize their employees to purchase and consume their prescribed preventive medication. In short, the co-payment was removed or reduced for these type of drugs in hopes that it would prevent future medical procedures for the patient. This strategy turned out to be extremely successful and saved companies and insurance organizations millions of dollars. Shortly after the 2008 presidential election the Obama administration was creating value-based policies for government healthcare plans.
In reality the switch from FFS towards payment models that focus on value have become more popular since the creation of Obama Care. Today 90 percent of healthcare executives expect the industry to be completely transitioned from volume to value within the next 10 years. Influences on the shift to value-based care include the rising healthcare costs, stakeholder’s push for value and strong support from the government for new payment methods. Combining these factors with the highly favorable results seen by patients and it is clear that value-based care models are here to stay.
Value-based Care Advantages
Value is the main criteria looked at for insurance companies and the healthcare providers pay is based on the quality of care rather than the number of exams, procedures, tests, etc. that were conducted. This concept clearly enhances patient engagement since the main focus is on value instead of volume.
Providers are heavily incentivized for performing proactive care procedures that prevent and manage chronic disorders and focus on keeping patients healthy. Shared data from different care providers is assessed to recognize possible health risks, improve patient care and increase efficiency of overall healthcare delivery. Customers are treated with more respect since they are at the core of the service and the entire healthcare team operate in-sync to keep their patients at optimum health.
Value-based Care Delivery Models
- Accountable Care Organizations (ACO). These are group of medical providers and investors that voluntarily share financial and medical responsibilities for providing healthcare services to patients. All physicians will have a shared goal to limit unnecessary spending while ensuring patients receive the right care since they are all invested in the ACO.
- Pay-For-Performance (P4P). This allows doctors to be paid based on the quality of service they provide. Using factors like patient engagement, patient satisfaction, care coordination and health outcomes will determine the reimbursement amount for the provider. The idea is that by using quality of service as a basis for payment will result in better care and health outcomes to patients.
- Capitation. Caregivers contract with independent practice association (IPA) and are financially incentivized to provide appropriate healthcare designed to improve patient health. The group of caregivers are paid a set amount for each patient to provide healthcare for a given number of months. This model incentivizes doctors to focus on preventive care to avoid costly or unnecessary treatments that can’t be reimbursed.
- Bundled Payments. Also known as episode payments, is grouping provider services related to the same treatment or condition into a single payment. This improves patient care and reduces healthcare costs since all included physicians use the same pool of money. Providing complete treatment as quick as possible will benefit all involved in order to maximize their reimbursements.
The days of providers having to handle both value-based and FFS payment models are soon to end. Given the benefits and cost savings it is clear that the healthcare industry is headed towards being solely value-based. Everybody needs healthcare and we all benefit since value-based care models are here to stay.