The adoption of value-based care is expected to account for 59 percent of healthcare payments by 2020.
Traditionally, providers have been accustomed to the fee-for-service model of healthcare. Essentially, this meant that providers bill for each procedure performed on a patient regardless of the quality of care received or if these procedures were necessary. Now, the tides are changing. Healthcare is moving towards a new model – value-based care.
What is value based care?
Value-based care, put simply, is reimbursement to providers based on the quality of care delivered. This model rewards providers for providing effective and efficient care to their patient base. This model is expected to replace the fee-for-service model that physicians utilize now. Accountability is a key goal.
One of the main difference that providers are seeing with this switch is the focus moving from quantity of services rendered to quality of services. Value-based care places more emphasis on providing better care, improving population health initiatives, and reducing healthcare costs across the board.
The new model is about patient outcomes. This means there should be a visible reduction in the amount of hospital readmissions and preventative care should see an uptick. Practices need to utilize 2015 Edition EMR which will allow them to send referrals to other members of the patient’s care team.
How does value-based care work?
With this model, the amount of the reimbursement is calculated based off of numerous measures of quality and the overall health of patient populations. This differs very much from the fee-for-service model. Providers now need to track certain metrics in order to show that their patients exhibit improvement. These improvement measures may include…
- fewer hospital readmissions,
- fewer medical events (adverse),
- population health,
- and more.
Providers are now seeing new incentives to utilize Health IT tools like clinical decision support and population health management. From there, these clinicians may choose to utilize data analytics or take information back into their EHR systems. Physician can then create reports and draw conclusions on the best way to proceed with patient care and services. Value-based care rewards providers coordinated, specific, and appropriate care for patients.
What value-based care models are there?
Accountable care organization:
ACOs are networks of clinicians (including hospitals) that provide care to Medicare beneficiaries. This group of care providers also aims to reduce redundancy in services while reducing room for medical errors. All clinicians within an ACO benefit if a high quality of care is provided to the patients. The potential pitfall of being a part of an ACO is the risk of potentially having to repay Medicare if a high quality of care is not presented.
This type is referred to as an episode based payment. The best way to explain this is through an example. Say that you have a patient who needs to have surgery, the overall payment from CMS would be combined across the care team. This means that the hospital, surgeon, and anesthesiologist’s payment would all be bundled instead of paid separately. The provider’s job here is to find ways to decrease the costs of the overall services below the bundled payment price while still providing a high quality of care. If they accomplish this, they can then pocket savings.
Patience centered medical homes:
Primary care offices that have received PCMH certification are already committed to provide patient centered care. They are dedicated to team-based models, population health initiatives, care coordination, and quality of care. This puts PCMH certified practices and clinicians in great shape for value based care. It is reported that a Colorado PCMH certified organization saved $98 million and increased their quality score by 10% over the course of a year through value based care.
As you can see, value-based care is a shift, but for some the shift has already started. This model has the potential to benefit all involved, we just have to do our due diligence to provide high quality of care and reduce healthcare costs.