Value-based care is an operational model rising in popularity in the healthcare industry. It is a system based more on quality of service than quantity. It is proving an effective alternative to traditional fee-for-service reimbursement systems, which pays providers retrospectively for services delivered.

These models center on patient outcomes, highlighting a need for healthcare professionals to become proactive in improving a patient’s quality of life, based on specific measures. Reduced hospital readmission and improving preventative care through certified health IT are the goals in value-based care. 

While this is a far cry from the system that is currently in place, it could revolutionize the way the healthcare industry operates. 

How have value-based care models been implemented?

One of the ways value-based care programs have been implemented is through Accountable Care Organizations (ACOs). Such organizations are made up of doctors, health professionals, hospitals, and other providers who give coordinated and high-quality care to their beneficiaries. The system they use enables them to avoid redundant services while reducing medical errors.

The Medicare Shared Savings Program, Advance Payment ACO Model, or the Pioneer ACO Models are just a few of the ACOs healthcare providers can volunteer for. The benefit of joining is that the network of providers shares the savings if high-quality care is delivered at lower costs.

As part of volunteering for an ACO, providers assume some financial risks. If the agreement is successful, the potential for savings is great, but that does not eliminate the possibility of shared losses. If providers are unable to provide high-quality care, they may have to repay Medicare.

What are bundled payments?

Bundled payments or episode-based payments are single payments for services provided to an entire “episode” of care. Any providers that become involved in the care of a patient are reimbursed for the expected costs to treat the patient’s specific condition. 

The more the providers are able to decrease the cost below the bundled payment price, the greater the profit they can earn. If the costs of treating the patient exceed the bundled payment, they would collectively have to bear the financial loss. 

How do patient-centered medical homes work?

Patient-centered Medical Homes (PCMH) is another model that focuses on coordinating patient care through a primary care physician. Through the PCMH, a centralized care setting is provided and designed to manage the patient’s different needs. 

A special PCMH certification is required for this, as it ensures that providers will provide patient-centered care, team-based methods, population health management, personal care management, care coordination, and consistently high-quality care. A personal, one-on-one relationship between the healthcare provider and patient is essential to this model. 

How successful are these value-based programs?

More patients are growing interested in value-based care models, as the 34 percent of payments made to healthcare providers in the last five years has gone into value-based care programs. PCMHs all over the country are also reporting better profits and savings and a vast increase in their quality scores in as little as one year. 

Final thoughts

While not without its pros and cons for healthcare providers, value-based care can give patients a better and more affordable option with regards to their healthcare. It ensures the highest quality of care for less money and encourages cooperation among medical professionals. If you’re considering a form of long or short-term care, it might be beneficial to consider value-based options. 

If you’re looking for value-based care programs, send us at Medistrics Health a message. We have the resources necessary to help you stay healthy at lower costs. 

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