Over the past few years, the future of value-based care has been uncertain. The challenges of lowering – costs and improving healthcare quality may lead payers to consider the use of captivated payments as part of their value-based payment model strategies.
The captivated payments are prearranged payments for healthcare providers to deliver services on a per member per month basis. Thereafter the providers are paid a set amount for each patient. It seems to be an extreme strategy for cutting costs, but fixed payments offer significant benefits to payers.
How is value-based care different?
In the traditional fee-for-service reimbursement model, healthcare providers were paid for the number of services that they performed. Due to this, many providers used to order unnecessary tests and procedures and manage more patients in order to get paid more. Each service was paid separately, there was no bundling of services.
But value-based reimbursements are calculated by using numerous measures of quality and determining the overall health of the population. The value-based care is driven by data. This is because the providers must report to payers about the treatment given and demonstrate improvement. For example, the providers are responsible to track and report all hospital re-admissions, patient engagement, adverse events, population health, and more.
Increasing the cost of healthcare is not sustainable but improves the outcomes for the money spent. This shift to value-based care is very advantageous to the patient population, as it delivers a connected care experience where patients receive more coordinated, appropriate, and effective care, improving the health of individuals and their communities.
In this technology-driven strategy, patients can manage their own path i.e. from primary care to any specialists. Now patients are able to see multiple providers and surgeons who do not interact but have access to common patient data. Whereas in the traditional fee-for-service model, providers lacked the technology and incentives to coordinate patient care across the health care system.
What value-based care models are available?
- Accountable care organizations (ACO) – This is designed to help providers give coordinated and good quality care to Medicare beneficiaries. Preventing unnecessary and redundant services, helps the providers to ensure that patients receive the most befitting care at the right time. In this model, there is more potential for savings. ACOs are an important part of the future as it is based on the quality and safety of the care.
- Bundled payments – means a single payment for the services provided for an entire episode of care. The providers are collectively reimbursed for the expected costs to treat a specific condition. The CMS combines the set payment, rather than paying separately to the anesthesiologists, surgeons, etc.
- PCMH (Patient-centered medical home) – is a care delivery model that focuses on coordinating patient-centered medical homes. It is designed to provide patients with centralized care, that manages the various needs of the patient. Because of this model, there has been some decrease in the emergency care units.
- Hospital value-based purchasing program (VBP) – This encourages hospitals to improve the quality and safety of acute inpatient care for all patients and also –
- Increase care transparency
- Recognizing a hospital’s high-quality care at a lower cost
- Eliminating adverse events that can cause harm to patients
How is value-based care useful?
The value-based care rewards the value of services and proactive management of health, preventing illnesses and injuries and catching them at an earlier stage when they are inexpensive to treat. The providers are always working to improve their patients’ health by responding continuously and consistently monitoring.
Perhaps the most difficult part of the value-based care is the extra tasks it adds, such as:
- Wellness coaching
- Obtaining authorization for procedures
- Documenting of quality measures
- Coordinating with care managers and social workers
These tasks theoretically increase the practice’s value-based reimbursement and reduce the time and energy dedicated to their fee-for-service patients. Now providers are spending more time reviewing data on their practice patterns and comparing them with other practices. Thus showing improvement in all aspects.
The benefits of Value-based healthcare are:
- The providers become more efficient and possess greater patient satisfaction –quality and patient engagement measures increase the focus on value, instead of volume.
- Patients spend less money to achieve better health –the value-based care models assist in patient recovery faster and avoid chronic diseases like cancer, obesity, high blood pressure, or diabetes.
- Suppliers align prices with patient outcomes –due to positive patient outcomes and reduced costs, suppliers benefit from their products and services.
- The community as a whole becomes healthier while reducing overall healthcare spending –as less money is spent on helping people manage chronic diseases and costly hospitalization and medical emergencies.
- Payers’ controlled costs and reduced risk –a healthier population with fewer claims shows an increase in efficiency by bundling payments that cover the full patient cycle.
Value-based care differs from a fee-for-service or capitated approach; in which the providers are paid based on the number of healthcare services they deliver. And the ‘value’ in this value-based healthcare means measuring health outcomes against the cost of delivering the outcomes. It is a framework for restructuring the healthcare systems around the globe.
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