5 Advantages to Value-Based Care

Many healthcare systems were built for the fee-for-service era. You probably get reimbursement from payers based on the number of services you offer. It is easy to see the conflict this creates for providers who want to reach their goal of reducing a patient’s need for medical care while keeping the lights on. Thankfully, things are changing. The switch to value-based care might be daunting, but the benefits are vast and long-lasting. 

As the entire industry shifts toward value-based healthcare models, providers must keep pace to stay profitable and competitive. Over 40% of health care payments went through models that offered some kind of value-based reimbursement, and 85% of payers feel it will result in more affordable care. Value-based care is only expected to grow — take a look at what the shift means for your practice.

How Does Value-Based Healthcare Work?

Value-based care is a broad framework that refers to efforts to incentivize providers to deliver higher-quality care, despite a reduction in services. A range of initiatives have appeared to support these goals, including:

• Accountable Care Organizations (ACOs): ACOs are networks of providers and systems that share the responsibility of care coordination, allowing for collaboration and cost-sharing practices.
• Bundled payments: Bundled payments combine the reimbursement for a group of providers into one sum, incentivizing providers to coordinate care efficiently and reduce costs below the reimbursement amount.
• Patient-centered medical homes (PCMHs): A PCMH model uses the patient’s primary care physician as an “entry point” for managing various health concerns. It uses a team-based approach to build one-on-one relationships and deliver patient-centered care.

To receive the financial benefits of these programs, a provider or healthcare system must provide evidence of its success. They must collect detailed information on metrics like population health, hospital readmissions, adverse events and patient engagement. As payers see improvements in these metrics, they offer higher reimbursement amounts because they know the providers are saving them money by keeping patients healthier.

For example, say a patient has been diagnosed with prediabetes. If unmanaged, the patient could quickly become diabetic and incur the expensive treatment costs that come with the condition. On the other hand, if the patient is enrolled in a coordinated effort to manage it, such as regular lab tests, extensive patient education and check-ins with a nurse, they could maintain or even reverse the condition. 

The costs of these preventative activities are typically minor when compared to the price of diabetes management and associated comorbidities, like hypertension and depression. Thus, the payers save in the long run and are happy to reimburse providers who help them do so.

5 Benefits of Value-Based Care

Of course, the benefits of value-based care reach much further than the bottom line. Here are some advantages of value-based medicine for providers, payers and patients.

1. It Rewards You for Fewer Visits Per Patient and Better Population Health

First and foremost, value-based care allows providers to fulfill their goal of improving the overall health of their patients while maximizing revenue. In the past, fewer visits and better patient health would result in reduced payments. With value-based care initiatives, providers are rewarded for reducing the instances of adverse health events. They can essentially get more money for fewer visits and a shift toward preventative services.

Along with improving patient health, this reduced demand can allow providers to see more people and expand their reach. In a time when many fields of medicine face shortages, this increased ability to serve the public can make a significant difference in access to care.

2. It Allows You to Meet More Patient Needs

Many providers know their patients can benefit from more comprehensive care or that their practice could be more productive with certain technologies, but they do not have the resources. Chronic conditions, for example, often require robust patient education and require the patient to enact lifestyle changes, which is hard to offer in a fee-for-service model. Value-based care allows providers to implement the changes they need with financial support.

You might be able to improve communication with other providers, implement detailed patient education plans or provide regular check-ins to monitor the patient’s condition. With value-based care, providers have more support for addressing complex healthcare demands.

3. It Helps You Improve

Since value-based care is dependent on data collection, it paves the way for practices to collect and act on valuable new insights. Providers are encouraged to improve their metrics, which might take a variety of initiatives, from implementing patient portals to automating processes and assessing interactions from the ground up. With clear goals in mind, practices can make influential changes to improve the reach, success and cost-effectiveness of their care.

Some value-based care initiatives are based on a practice’s performance relative to other practices, so it promotes continuous improvement and a need to keep learning. Better data collection can extend far beyond the requirements for value-based care reimbursement to support other practice goals, too. 

In other words, it sets the foundation for long-term analyses that help practices strive for better care. You might, for example, use your data to identify patients who have not been seen in over a year and get them in for preventative care. It supports proactive behaviors that would otherwise be virtually impossible.

4. It Can Provide Significant Savings for All Parties

Value-based care is structured to deliver considerable savings for everyone, not just the payers:

• Providers: Higher reimbursement amounts and operational improvements can help providers spend less on delivering care while receiving more for their work.
• Patients: With fewer visits to the doctor and better health, patients can minimize their spending on copays, premiums and medications.
• Payers: A shift toward preventative health and better outcomes limits the costs that health insurance companies and other payers are responsible for.
• Taxpayers: Since CMS covers a large portion of healthcare in the United States, the savings it sees as a payer also extends to taxpayers.

5. It Looks Better to Your Partners and Patients

All of the improvements that providers make to show their success in value-based care can greatly boost their image. For example, if you find that you need to increase patient engagement to receive reimbursement under a specific program, you might implement new technology solutions. Since many patients want modern tools from their providers, like text communication and appointment scheduling, those changes could also be a significant selling point to help you get more patients in the door.

Strong performance metrics look good to just about every partner, like payers, other clinicians, technology providers, community partners and suppliers. The better your facility performs, the more leverage you may have in discussions and negotiations. Consider the effect of a prestigious award, like the one that Renal Physicians of Montgomery County, P.A. received after increasing their reporting to 100%.

Start Analyzing With Tangible Solutions

The underlying current of any successful value-based care program is strong data collection and analysis. Here at Tangible Solutions, we offer Happe-Analytics, a robust reporting tool for healthcare organizations looking to make impactful changes and understand everyday operations. It integrates with your EHR and can help practices and providers back their value-based care initiatives with cold, hard data. With tools for easy reporting and visibility, we can streamline your journey to value-based care and help you reach maximum profitability.

Reach out to a knowledgeable representative today to learn more about Happe-Analytics and its role in value-based care.