As healthcare providers, you’re paying more of your health care costs and making more of your own care decisions. There are both opportunities and challenges tied to value-based care. Those costs can seem out of control, but now health plans, doctors and health care systems are beginning to work together on solutions that will benefit your wallet and your health.Those who can deliver on cost, quality and patient outcome measures are able to earn financial incentives and avoid penalties.
What is Value based Care?
Value based care is a clinical inefficiency and duplication of services, and to make it easier for people to get the care they need. This form of reimbursement has emerged as an alternative and potential replacement for fee-for-service reimbursement which pays providers retrospectively for services delivered based on bill charges or annual fee schedules. Overall wellness, quality of care, and preventive screenings all are key to bringing about better outcomes.
What does that mean for you?
Value-based care is designed around patients. Medical care teams zero in on individual needs, whether preventive, chronic or acute. It coordinates your care, and technology that connects you and your providers with information to help you get the right care across the health care system.
As many explore alternative solutions, one solution that has been embraced by some is value-based care delivery models. There are four models in action.
- Accountable care organisation (ACO): An Accountable Care Organisation (ACO) is a group of healthcare providers who agree to be jointly accountable for both the quality and the cost of the healthcare of a defined patient population. ACOs are alliances of doctors, hospitals and other health care providers that deliver and coordinate care for their patients. Doctors and health systems that successfully manage the health of the entire population reap the rewards. However, if they do not improve quality and control the cost of care, they may lose money. For you, that means a team of providers is incensed to work together to keep you healthy.The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
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- Patient-centred medical home (PCMH):A patient-centred medical home (PCMH) is a model of care that aims to transform the delivery of comprehensive primary care to children, adolescents, and adults.Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences.Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
- Pay for performance (P4P): It is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Doctors, hospitals and health plans together develop and agree to a set of quality and efficiency measures. P4P programs are supported by insurance providers, Medicaid or Medicare. P4P creates a system that rewards healthcare for efficiency and penalises for increased costs, poor patient outcomes and medical errors.
- Bundled payments: In a bundle payment arrangements are designed to pay multiple providers for coordinating the total amount of services required for a single, pre-defined episode of care such as hip or knee replacement. These payment models promote a coordinated, efficient and cost-conscious effort for specific treatments or conditions. Bundled payment rates are determined based on the costs expected for a particular treatment, as well as costs for any preventable complications that may arise.
“Value-based care models are highly attractive to healthcare providers. This module is designed to help your practice make the shift towards this model so that your patients and team can reap the benefits of this outcomes-focused approach that incentives high quality, patient-focused care and reduces overall health care costs.”
