Since the term was first coined 17 years ago, value-based healthcare has evolved from an innovative concept to an emerging practice among healthcare organizations worldwide. Already, a growing number of providers have begun measuring and tracking patient health outcomes against the cost required to deliver these services. This data was then used to identify best practices and overhaul traditional models of patient care. Now, payers are introducing value-based payment models to incentivize switching to value-based care.
Value-based healthcare is quickly becoming a method for improving the performance of individual healthcare organizations and transforming how entire health systems operate and are managed. In recent years, the coronavirus pandemic only accelerated this transition, as it shed a harsh light on the recurring challenges health systems worldwide face. Though value-based care is still gaining a foothold, it is difficult to ignore its effects on the medical industry.
This model of patient care is centered around improving the quality of healthcare for patients and preventing problems before they begin. The focus on prevention lowers the need for expensive medical tests, ineffective medications, and unnecessary procedures.
In a value-based system, providers such as hospitals and doctors are paid based on patient outcomes rather than for every service they provide. In other words, medical practitioners are rewarded for helping patients become and stay healthier. This is a proactive response rather than a reactive one. This helps cut patient costs for everyone.
Value-based care models emphasize an integrated team approach toward patient care and sharing patient data, making it easier to measure outcomes and coordinate care. These models can also range from accountable care organizations (ACOs) to bundled payments, each with its methods of implementing comprehensive, value-based health care.
Patient-centered medical homes are one example. These are not physical locations; instead, this refers to a team of physicians and personnel managing a patient’s primary care to increase the quality and coordination. Care is usually coordinated through the primary care physician, allowing patients to develop one-on-one relationships with their care providers.
ACOs, on the other hand, refer to a network of physicians, hospitals, and other healthcare providers who give Medicare beneficiaries coordinated, high-quality care. They also aim to prevent unnecessary and redundant services while reducing medical errors.
Currently, providers can volunteer to participate in an ACO, such as the Medicare Shared Savings Program. While there is some financial risk in joining, the potential savings are often significant enough to offset the risk.
Bundled payments are another of the more popular value-based models. There is a certain level of risk, though. Providers are only able to pocket the savings if they can decrease the cost of the services below the bundled payment price. If it goes above the payment price, providers bear the financial loss.
Studies of value-based care programs have so far suggested that they can reduce costs and improve the quality of care, although results continue to be mixed, and the impact is modest. The promise of this model is also dependent on prevention, which is difficult to measure. Healthcare organizations have no easy way to identify what adverse outcomes may have been avoided, and the benefits take time to materialize, which might not initially produce short-term savings for patients or their primary care providers.
Despite this, there has been some evidence of reduced healthcare costs, improved quality of service, increased patient satisfaction, and an overall reduction in costly medical errors. As healthcare providers align their focus with that of their patients, they are more likely to take the time to get to know their patients and their medical concerns to issue an appropriate diagnosis rather than focusing on constant trial and error.
This is especially beneficial to larger employers, such as hospitals, since medical errors are a concern for many insurance sponsors. Some programs also enable providers to transform how they deliver this care by promoting collaboration across care teams and encouraging providers to spend more time on services that generally were not covered under fee-for-service models, such as counseling or screening for social needs.
The complexity of modern medicine and the healthcare industry will never go away. However, effectively managing a complex adaptive system should not mean creating increasingly complicated management systems. The founding principle of value-based healthcare, after all, is that every healthcare system should be able to deliver the best possible health outcomes compared to money spent. The individual patient is put at the very center of the health system.
Though improving a patient’s health outcomes relative to the cost of care has often been a goal across the healthcare system–– from patients and providers to employers and government organizations–– coordinating these efforts has not been as successful under the traditional model. Under value-based care, the individual goals of these diverse parties may be met as organizations shift to this structure. By focusing on the outcomes that matter most to patients, value aligns with treatments and how patients experience their health.
Health outcomes can then be described and measured by capability, comfort, and calm. Capability encompasses the ability of patients to perform tasks they need to live their life to the fullest. Comfort and calm refer to the relief from physical and emotional suffering and having peace of mind, knowing they can easily access care should the need arise.
Value-based healthcare also matters because it may help physicians and other providers reconnect with their original purpose as healers. The pandemic exacerbated clinician burnout, and the industry is still recovering. By having visible results and contributing to the health of an entire population, some suggest that value-based care will only encourage physicians in their efforts to improve overall health outcomes.
Ultimately, this new model of care is a means of achieving the aspirational goals of healthcare organizations worldwide. It can potentially improve the patient’s experience of care, improve the health of populations, and reduce the per capita cost of healthcare while improving clinician experience and burnout. Value-based care is still a new concept for many healthcare providers, but more organizations are trying to implement its values into their workflow.
Unfortunately, making the shift to value-based care is a time-consuming process. Many providers are already busy managing their patient load and office staff, leaving little room to handle the business side of their practice. Good Stewart Consulting is here to help.
Our staff is highly knowledgeable, with years of experience in the health care sector. Transitioning to a value-based care model can take away precious time spent with patients, addressing their needs. Instead of trying to balance both, trust the experts to implement the changes for you. Contact Good Stewart Consulting today to learn more about how we can help you!