What Exactly is Value-Based Care? A Broad Overview

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Value-based care is a health care delivery model that pays providers based on the health outcomes of their patients and the quality of services rendered, rather than the number of services they provide.

Value-based care (VBC) struts onto the healthcare scene as a trendsetter, determined to revolutionize the way we approach patient well-being, chronic diseases, and dreadful medical bills. With a swish of its metaphorical cape, VBC swoops in to rescue patients, providers, payers, and society at large from the clutches of inefficiency. Armed with incentives for top-notch health outcomes, savvy resource management, and patient happiness, it’s like the Avengers of healthcare models. Picture bundled payments, shared savings, pay for performance, and capitation marching in a parade of innovation, ready to fight the villains of exorbitant costs and subpar care.

When did VBC Start?

Up until the 1990s, care was delivered and charged without a lot of concern for quality or patient satisfaction. In 2006 Michael Porter and Elizabeth Olmsted Teisberg introduced the phrase value-based health care in their book Redefining Health Care. This book defined value as the health outcome per dollar of cost expended and argued that competition based on value would improve health outcomes and lower costs.

In 2008, Blue Cross Blue Shield of Massachusetts implemented its Alternative Quality Contract (AQC), which gave providers a ‘global budget’ to manage the overall spend on their patients and included both clinical quality and patient satisfaction measures. A study showed a 12% slow in spending under this contract.

After experimental programs delivered measurable results, the push for VBC increased. In 2010, the Affordable Care Act (ACA) was passed, which established the Center for Medicare and Medicaid Innovation (CMMI) to design and test new value-based care programs. One of the biggest programs implemented by CMMI was the Accountable Care Organization (ACO), which allowed providers to form groups that could earn financial rewards by taking responsibility for caring for a defined group of Medicare beneficiaries and improving the care they receive.

The Benefits of Value-Based Care

Many programs are included in value-based care, for example, preventing surgical infections, reducing patient falls, and improving smoking cessation programs. The common threads through all of these programs are the intent to improve care, reduce costs, and improve population health.

Some of the benefits of these programs are:

  • Lower health care costs. Value-based care models aim to reduce unnecessary or ineffective services, prevent hospitalizations and readmissions, and manage chronic conditions more effectively, which can lower the total cost of care for patients and payers.
  • Higher patient satisfaction. Value-based care models focus on improving patient experience and engagement, by providing more personalized, coordinated, and convenient care that meets patients’ needs and preferences.
  • Reduced medical errors and risks. Value-based care models encourage providers to follow evidence-based guidelines and best practices, use data and technology to support decision making, and collaborate across care teams, which can improve quality and safety of care and reduce errors and complications.
  • Better-informed patients. Value-based care models empower patients to take an active role in their own health, by providing them with information, education, and tools to manage their conditions, access preventive services, and make informed choices about their care options.
  • Improved population health. Value-based care models aim to address the social determinants of health and health disparities that affect different groups of people, by providing more accessible, equitable, and culturally competent care that improves health outcomes and reduces health inequities.

Challenges of Value-Based Care

Change is hard, and even a phased implementation of value-based care has been challenging for many organizations. Some of those challenges are:

  • Lack of resources. Providers may need to invest in new technology, infrastructure, staff training, and data analytics to support value-based care models.
  • Technology interoperability challenges. Providers may face difficulties in sharing and accessing data across different systems, platforms, and organizations, which can affect care coordination, quality measurement, and performance reporting.
  • Financial risk and unpredictable revenue streams. Providers may have to bear some or all the financial risks for the outcomes and costs of their patients, which can expose them to losses if they fail to meet quality or efficiency targets. They may also face uncertainty in their revenue streams due to changes in patient mix, payer contracts, and reimbursement rates.
  • Shifting policies and regulations. Providers may have to comply with different and changing rules and requirements from various payers, regulators, and accreditation bodies, which can increase administrative burden and complexity.
  • Difficulty collecting and reporting patient information. Providers may struggle to capture and report accurate and complete data on patient outcomes, quality measures, and costs, which can affect their performance evaluation and payment adjustments.

In the pursuit of reaching value-based care goals, organizations must develop smooth processes and data that supports their efforts. FormDr helps leading organizations provide online HIPAA compliant forms that support care initiatives and improve patient engagement.

Completely customizable online form templates ensure providers have the tools to support value-based workflows. For an overview of how FormDr can help your practice by streamlining operations and providing more care for each healthcare dollar, schedule a consultation call today.