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What Is Value-Based Healthcare?

April 29, 2019

As an oncology provider, the term value-based healthcare is often used in discussions regarding payment and patient care. But what exactly does value-based care mean?

Let’s unpack some of the key pieces of this framework.

 

Quality Versus Quantity

Value-based care is a method of reimbursement that rewards providers for two things — efficiency and effectiveness. This concept is closely associated with the triple aim of providing better patient care, improving population health, and reducing healthcare costs.

Value-based care emphasizes the quality of care, specifically around measures regarding patient readmissions and improving preventative care. It also rewards the use of technology.

This differs from a traditional fee-for-service reimbursement, which is a transactional reimbursement based on billing or a standard schedule. In this model, because providers received payment for each procedure performed, healthcare goals became very mechanical, focusing on efficiency and quantity of services provided rather than the effectiveness of medical treatment.

In other words, value-based care rewards quality of care, while fee-for-service rewards quantity in care services.

 

More Data Required

So, how is value-based care measured? The short answer is data. Healthcare providers that are using a value-based approach are required to provide data to display that these core care objectives are being met. Metrics like hospital readmissions, patient engagement, and population health are benchmarked and providers have the responsibility of demonstrating improvement over time.

This data requirement does increase the burden on providers who are now required to keep track of these metrics. However, if a provider can use this data to demonstrate that patients are receiving more effective care, that provider is rewarded with larger reimbursements.

 

The Benefits

In addition to improving the overall quality of care delivered, there are a number of benefits to a value-based approach.

For patients, it means reduced costs. Because providers are rewarded for effective treatment, unnecessary tests, procedures, and medications are reduced.

For providers, it means happier patients. Because patient satisfaction is a key metric in the Merit-based Incentive Payment System (MIPS), this is a tangible, and substantial, benefit. In addition, it also means better efficiency due to the lack of needing a high volume in performing services.

Healthcare payors and suppliers see benefits in pricing alignments.

And lastly, the one constituency often overlooked is society as a whole. In a value-based approach, the population being measured not only is healthier, but it pays less for care.

 

Patient-Centric Care

At Verdi Oncology, providing the best patient care is what matters most. Our medical model not only ties in closely with our belief that patient-centric care is the key to successfully treating oncology patients, but it is also a proven method of implementing a value-based system.

In a patient-centric care model, the patient’s treatment is coordinated by a primary physician that works with other specialists and caregivers to provide a strategic approach to care. This means that electronic medical records (EMRs) are shared easily between providers, allowing transparency in tests and other medical procedures being performed by other members of the care team.  

 

Challenges still exist

One of the biggest challenges in implementing value-based care is the current structure of the healthcare system in the United States. While the Centers for Medicare & Medicaid Services (CMS) are working to expand value-based care incentives, just 34 percent of all Medicare payments were made in a value-based system in 2017.

So, yes, we still have a long way to go.

However, these short-term challenges should not disrupt the broader goal of triple aim.

At Verdi, we work with oncology providers to help organize the data requirements of a value-based payment system to remain financially stable and credible with patients and referral partners. Contact us to learn more about how we help providers with value-based approaches to care.

 

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