What Is Value-Based Care and What Does It Mean for Providers?

What Is Value Based Care? 

Value-based care (VBC) is a healthcare model that reimburses providers based on the quality of care provided and the patient outcomes achieved. Put simply, with value-based care, a provider’s revenue is more closely tied to their ability to improve a patient’s health, as opposed to the number of services provided to them. 

For more than a decade, there has been an emphasis on making a shift from the current fee-for-service payment model (where providers receive payment for each service rendered, emphasizing volume) to a fee-for-value payment model (where reimbursement coincides with the quality of care provided to the patient), largely led by the Centers for Medicare and Medicaid Services (CMS) and its programs for value-based care. 

Now more than ever, oncology organizations are embracing VBC as a way to better patient outcomes while managing the costs of care. 

What Are the Benefits of Value-Based Care? 

The most obvious benefit to value-based care is that patients benefit from the increased focus on the following:  

• Improved patient outcomes by providing high-quality measures reduces the need for increasingly more care associated with progressive and chronic conditions
  
  
• Reduced care costs by eliminating redundant and/or unnecessary tests and procedures 
  
  
• Increased patient engagement because providers are taking a comprehensive look at the patient’s health, not merely focusing on an acute episode, enabling better insights for all the stakeholders in the healthcare system for better patient-centered care 
  
  

How Is Value-Based Care Different from Fee-for-Service? 

Value-based care (VBC) creates accountability and incentives for providers to self-evaluate, coordinate, and work to produce better outcomes. Examples of value-based care models include: 

• Alternative payment models, such as bundled payments or shared savings, in which all departments in a healthcare provider share financial risk and reward and are motivated to work more efficiently as a whole 
  
  
• Patient-centered medical homes that act as a centralized setting through which a patients’ primary care provider coordinates all aspects of care  
  
  
• Accountable care organizations (ACO), or networks of multiple providers, single practice providers, and hospitals who coordinate, sharing data between medical teams, to provide care to Medicare patients 
  
  

Through their fee-for-value programs, the CMS tracks various data sets regarding patients, such as but not limited to: 

• Doctor recommendations, like therapy 
• The number of times the patient visits the emergency room 
• Whether patients are going to hospice
• Mortality rates
  
  

However, without patient data and the technological infrastructure to both analyze and share it, value-based care may be difficult to achieve.  

Technologies for Value-Based Care 

Organizations that integrate value-based solutions and analytical software into their own systems are often more successful than those who do not leverage these solutions. Providers have cited inadequate software for capturing and analyzing data as a key hurdle to succeeding in a value-based model. Thus, organizations looking to succeed with value-based care need to evaluate using advanced analytics that integrate clinical, financial, genomic and sociodemographic data to identify opportunities for clinical improvement and cost drivers. 

As CMS continues to optimize current value-based reimbursement models and create new ones, the reality of value-based care becomes clearer and the transition to improving care outcomes for patients while decreasing care costs grows closer. One thing is for sure--those who adopt the technology tools to implement value-based care sooner will surely be ahead of the curve. 

Sources:
https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558
https://www.mhaonline.com/blog/fee-for-service-healthcare
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs
https://www.definitivehc.com/blog/value-based-care-2019-survey-results
https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558