Understanding Value-Based Care

For many years, primary care providers have been reimbursed on a fee-for-service pay structure that is based on bill charges or annual fee schedules. This payment model promotes the quantity of services and has been the standard in medical professions for decades.

In an effort to shift away from the fee-for-service model, the Centers for Medicare & Medicaid Services (CMS) introduced a new value-based care approach. In this article, we’ll explore what value-based care is, how it helps primary care providers and patients, and how we can continue to improve this process.

What Is Value-Based Care?

Value-based care switches focus from the quantity of services to the quality of service. This means improving the overall care experience to help keep patients healthier longer. The three parts of value-based care include:

Better care for every individual
Improving health management strategies
Reducing health care costs

Instead of using the fee-for-service model where health care providers are paid for the amount of services they do, value-based care payments are based on patient outcomes. Providers report on specific metrics and data, including hospital readmissions, adverse events, population health, and patient engagement to help determine overall improvement.

Value-Based Care Programs

To help make value-based care the standard for primary care providers and post-acute care facilities, many programs follow three tenets of this type of care, including:

Shared Savings Program
Pioneer Accountable Care Organization (ACO)
End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
Hospital Value-Based Purchasing (VBP) Program
Hospital Readmission Reduction Program (HRRP)
Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
Hospital-Acquired Conditions (HAC) Reduction Program

Benefits of Value-Based Care

Patients

With value-based care, patients receive more comprehensive care that focuses on faster healing and preventative care while keeping health care costs lower.

Providers

Health care providers enjoy better patient satisfaction and are more effective at treating short-term issues and preventing long-term problems.

Society

Value-based care has a ripple effect on society as a whole since people are staying healthier, reducing recurring illnesses, preventing hospital readmissions, and spending less on health care costs.

Improving Value-Based Care

Value-based care can be improved in any health care facility by implementing a few key improvements:

Increase support for all care providers and medical teams
Commit to long-term quality improvement
Align internal and external goals

When you and your team are committed to providing the best quality care for your patients, all your other goals can fall into place and work toward improving value-based care.

Moving Forward

As we strive to make value-based care the future of health care, we’ve seen it’s usage rise throughout the years. In 2020, 36% of physicians are implementing value-based care and that number is expected to continue rising in years to come. CMS has introduced a detailed roadmap to help every state in the country move forward with value-based care and improve the quality of care for all patients.