While the US healthcare system continues to make extraordinary advancements in medical innovations, such as new treatments, devices, and therapies – when it comes to the operational side of things, we’ve got a lot of work to do to catch up with other developed nations. Our healthcare spending per capita is more than $12,000 a year, which is more than 40 percent higher than Switzerland, the next country behind us. While many believe we need total healthcare reform, most healthcare executives debate that it’s payment reform we really need. Fortunately, the transition to value-based care checks both boxes. Value-based care changes the way providers, payers, and patients work together to achieve better value and better outcomes in healthcare.
What is value-based care? While definitions vary depending on who you ask, the New England Journal of Medicine explains it like this:
‘Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.
Value-based care differs from a fee-for-service or capitated approach, in which providers are paid based on the amount of healthcare services they deliver. The “value” in value-based healthcare is derived from measuring health outcomes against the cost of delivering the outcomes.’
The Centers for Medicare and Medicaid Services (CMS) explains it similarly:
Under value-based care, providers are reimbursed based on their ability to improve quality of care in a cost-effective manner or lower costs while maintaining standards of care, rather than the volume of care they provide. Value-based care arrangements may also permit providers to address social determinants of health, as well as disparities across the healthcare system. Value-based care may also help ensure that the nation’s healthcare system is better prepared and equipped to handle unexpected challenges, including the ongoing COVID-19 pandemic.
Regardless of how you define it, value-based care addresses numerous challenges facing the US healthcare system. It also aligns well with the Institute for Healthcare Improvement (IHI)’s Triple Aim, which, much like value-based care, strives to achieve the following three goals to improve the delivery of healthcare in our country.
- Improve the patient experience: The journey to value-based care is a very patient-centric transition, with healthcare providers engaging patients in new and innovative ways to improve outcomes and reduce costs. From new technologies, initiatives, and programs all designed to keep patients adhering to their plans of care (which reduces the likelihood of bad outcomes), patients are becoming more connected to their care teams and providers. All these changes drive quality and value, which are certain to result in happier, healthier patients.
- Improve the health of populations: Value-based care’s focus on improving quality means better outcomes. Extrapolated over a large population, better outcomes result in healthier communities. Value-based care has paved the way for innovative initiatives such as the concept of a primary care medical home, where the patient is being closely monitored to ensure all routine screenings and wellness checks are scheduled on-time. Other models of care such as the accountable care organization (ACO) are helping improve the health of larger groups of patients through the use of data and better coordination of care.
- Reduce the per capita cost of health care. The shift to value-based care has opened the eyes of providers and healthcare leaders alike to new ways of thinking when it comes to reducing healthcare expenses. New reimbursement models have helped organizations engage providers in higher level discussions about how to work together to lower spending and enhance the coordination of care. Technologies such as electronic medical records, advanced data analytics tools, and the pursuit of interoperability have made it easier for providers to reduce the duplication of services while also ensuring patients are getting the care they need.
Moving toward value-based care is not an easy transition for healthcare providers, but those organizations that are doing it right are already starting to reap the rewards – happier, healthier patients, higher reimbursement, and more efficient, streamlined and coordinated care.
GeBBS Healthcare Solutions offers a wide range of solutions to support the shift to value-based care. From outsourced solutions designed to lower costs to documentation and coding services that can improve quality and efficiency, GeBBS can support both providers and payers on the journey to value-based care. To learn more, visit gebbs.com or click here for more info.