The move to value-based reimbursement has been a buzzword for a few years now, but these payment models are still new to many of us in the community healthcare field. Value-based care seeks to pay providers based on healthcare outcomes, not volume. How could this move from volume to value benefit community health centers?
Benefits of Value-Based Care Delivery Models
The data is in and it shows value-based care is better healthcare for patients, providers, payers, vendors, and society. The Massachusetts Medical Society, in their NEJM Catalyst publication, lists some of the benefits of these new types of reimbursement models:
- Patients will spend less to receive better care. Chronic illnesses such as diabetes or COPD require long-term treatment. But value-based care models reward the provider and the patient for preventing these diseases in the first place.
- Providers will work smarter and patients will be more satisfied. Patient engagement increases when providers focus on prevention. Providers will experience less risk over the old capitated payment systems.
- Payers benefit as well, by improving cost controls and lessening their risk. Healthier populations mean fewer costs for everyone. Bundled payments increase efficiency, particularly for chronic conditions.
- Vendors can align their pricing around patient outcomes. This can help lower prescription drug prices or other costs associated with care delivery.
- When care is preventative under a value-based system, society becomes healthier. Less money is spent on chronic care and hospital admissions are reduced.
Value-based care is shifting the healthcare paradigm in an entirely new direction to a more proactive treatment model that rewards patients and providers for preventing illness—not treating it after the fact. This is changing some of the care delivery models across the healthcare space.
New Delivery Models Under Value-Based Care
Community health providers should pay attention to the new wave of healthcare delivery models and payment structures found under the umbrella of value-based care. For example:
- Medical homes are an effort to more carefully align and integrate primary, specialty, and acute care. A patient-centered medical home (PCMH) puts primary care back as the focus of care coordination. PCMH models share EHR patient data in a way that creates better collaboration between services that are (and have been) easy to silo. The emphasis on data sharing offers better, more coordinated care but also lessens care redundancies and cuts costs.
- Accountable care organizations, or ACOs, were designed by CMS to offer better care to Medicare patients. ACOs create a networked team of healthcare providers and facilities to coordinate treatment more effectively at a lower cost. ACOs share the risk amongst all care providers, and the incentives are geared to support improved care access and lowered costs.
In these areas, the idea of value-based care particularly aligns with the mission of community healthcare: Create efficiencies at the point of care for vulnerable populations, improve healthcare outcomes with preventative treatments, and expand access. For all these reasons, community care organizations should pay particular attention to the growing emphasis on value-based care in the United States.
UHC Solutions is the nation’s leading staffing agency devoted to community healthcare. We support programs that benefit the patients our clients serve. Talk with our team about how our work can benefit your community care organization.