Transitioning to Value-Based Care

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Value-based care is a system of reimbursement that aims to compensate providers for the care outcomes achieved rather than the volume of services provided.

Under value-based care, the emphasis is on the holistic care of the individual. Each part of the provider organization must understand the involvement of other parts and what other treatment plans have been prescribed. Here, clinicians become more than just providers of care but are also involved in the management of care under models such as accountable care organizations (ACOs).

It’s within this model of care coordination that certain challenges come to the surface; measuring outcomes and rising costs. Traditionally, a clinician relies on scheduled appointments to monitor a patient’s progress. Between each visit, there’s no way of knowing how a patient is progressing, or if they’re adhering to their care plan.

Digital technology can help build the structure needed to enable value-based care and give clinicians a systematic approach to capturing data. Both payers and providers can use that data across programs and geographical locations to analyze the effectiveness of care plans across a multitude of data points.

The Shift to Value-Based Care

Healthcare payment in the United States is undergoing transformational change today. With the rise in chronic illnesses coupled with the ever-rising costs of healthcare, the United States today stands at a crossroads as it contemplates how best to pay for health care. And that’s why there’s such a shift from a “fee-for-service” model, where the volume of services rendered is rewarded, to a value-based model, where quality of care is at the forefront.

Traditionally, healthcare providers are paid in a “Fee-for-Service” (FFS) model. Under this system, providers are reimbursed for the various services they deliver to patients. That is, the volume of services rendered is rewarded, rather than the quality of care delivered or better care outcomes. This fee-for-service payment model - dominant both in the U.S. and in many other countries - is now widely recognized as perhaps the single biggest driver of rising healthcare costs and poor care outcomes.

Changing the way medical services are paid for can bring about a sea change both in terms of improved outcomes as well as lowered costs.

Consider value-based care, a system of reimbursement that aims to compensate providers for the care outcomes achieved rather than the volume of services provided. Improved value of care can be defined as the delivery of better outcomes at lower costs. That is,

Value = Outcomes/Cost

When improved value is thus incentivized, it opens the possibility of providers opting to provide not just more affordable care, but also more beneficial ones. This address both the aspects of healthcare that are ailing under the FFS model - rising costs and poor outcomes. Additionally, with the focus now on value as outcomes over cost, there arises an incentive to move away from the duplication of healthcare services which contributes to rising costs.

Outcomes and costs are simultaneously considered, and payment is made for the integrated delivery of a variety of services. And revenue is contingent upon the appropriateness of care, utilization of resources and clinical outcome. However, while payers and patients are on-board with this model, one group is yet to be enamoured by it – Providers.  As the shift to value-based care moves forward, a few overarching standards a health care provider would need to adhere to are:

  • Publish treatment outcomes;
  • Measure expenses;
  • Keep electronic record;
  • Share data in an effort to provide the highest value to patients.

Also, to be reimbursed for their efforts they have to must ensure that payers have access to the outcomes as well as care plans for each patient.

Digital technology solved these problems in a silo manner. One solution for one problem. However, with tech advancements, providers can now look at deploying a single solution that takes care of the non-care focused tasks, thus freeing up valuable time and energy. With the help of Digital Technology

  • Healthcare outcomes can be meticulously evaluated by measurable metrics.
  • Multi-directional communication between all stakeholders can be maintained
  • Real-time measurement of data and insights can be achieved

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