Shifting from fee-for-service to value-based-service has caused providers to change the way they render services to their patients. The providers’ payments are now based on value of care instead of being paid by the number of visits. Though this value-based care is supposed to help providers give better care at a lower cost; the providers are still not able to achieve the required score, due to the penalties and lower reimbursements. The change in revenue does have some impact and the providers do face some challenges.
The health systems are assuming financial responsibility for the health of their patients making population health management to use data as critical success factor under value-based care payment. It is important for all healthcare systems to understand well-being of the community and know the patients who might need immediate medical attention and more resources.
The benefits of the value-based care are:
- The value-based care extends to patients, providers, payors, and suppliers. Patients spend less money to achieve better health. Value-based care is focusing on helping patients recover from illnesses and injuries and avoid chronic diseases. This way patients face fewer visits to clinics, fewer medical tests done, and spend less money on prescription medication.
- The providers achieve efficiencies and greater patient satisfaction. The quality and patient engagement measures, increase the focus on value instead of volume of tests done. The providers earning high incentives can also be rewarded under the value-based care and are not projected to any financial risk.
- The payors also control costs and reduce risk by spreading value-based care across large patient population. It gives healthier population with fewer claims. The payors are able to increase efficiency by bundling their payments with help of the value-based care payment model.
- Less money is spent helping people manage chronic diseases and costly hospitalizations and medical emergencies. This way, Value-based care has significantly reduced overall costs that is spent on the healthcare. Its aim is for the society to become healthier and at the same time reducing overall healthcare spending.
How does value-based care work with Medical Homes and Accountable care organizations
The healthcare settings are now following team-oriented approach to patient care and sharing of patient data so that care is well coordinated. This way the outcomes are measured easily.
A ‘Medical Home’ is not a physical location. Patient-centered medical home (PCMH) relies on the medical records (EHR). The goal of EHR is to put crucial patient information among all providers to see results of tests and procedures performed by other specialists. Thus, the provider can have more organized approach to the patient care.
In the hospital value-based program, hospitals receive payments based on the quality of care they deliver. The hospitals must:
- Reduce or eliminate adverse events
- Adaption evidence-based care, that gives best patient outcomes
- Changing some hospital processes create better patient care
- Increasing care transparency
- Recognizing hospitals that give high-quality care at lower cost
The Accountable care organizations (ACO) provide high quality of medical care to their patients. Here all the providers work as a network team to deliver the best possible care at the lowest cost. The individual providers are incentivized for the quality of the care. All ACOs are patient-centered organizations. The clinical and claims data are shared with the payors to demonstrate improvements in the outcomes (hospital readmissions, patient engagement and population health).
The future of Value-Based Healthcare
The transition from fee-for-service to fee-for-value is not that easy. The value-based care requires providers to invest in broad care management strategies. To drive their costs, the providers can work at integrating behavioral health and substance abuse into their care management processes and services. As the healthcare continues to evolve, the providers are increasing their adaption of value-based care models. The value-based healthcare lowers the cost while increasing quality care and helping people lead healthier lives.
In the value-based care, costs and outcomes are accurately measured. To improve the care, the providers must combine all types of data for each patient. The full care cycle for the patient’s medical condition is aggregated and clear communication is required. With the help of iPatientCare, your practice can create standardized templates for each medical conditions to improve usability.
iPatientCare’s interoperability standard enables your practice to collect structured data and enable communication among different providers, allowing easy extraction of outcomes, and active cost measures for each patient and medical condition.