From Volume to Value: Shifting to Value-Based Healthcare

From Volume to Value: Shifting to Value-Based Healthcare

Learn more about how the shift from fee-for-service towards value-based care delivery is affecting healthcare and patient populations.

A Brief Introduction to Value-Based Healthcare

Value-based healthcare is a different way of approaching patient care, prioritizing the quality of care delivered over the volume of visits and patients, also known as the fee-for-service (ffs) payment model. By providing better care, more preventative screenings, and higher health care patient and caretaker engagement, providers can lower costs and prevent emergency room visits. The shift towards value-based care prioritizes the quality of patient care over the quantity of visits (the fee-for-service model).

The Triple Aim of Healthcare

Value-based healthcare encompasses the Triple Aim of Healthcare. The Triple Aim, defined by the Institute for Healthcare Improvement, includes the following:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

These core aims drive value-based healthcare.

The Quadruple Aim of Healthcare

Quadruple Aim is an emerging framework that builds on the Triple Aim by including work-life balance and joy in work. Addressing physician and staff burnout is incredibly important. By managing the work-life balance and finding joy in work, focusing on the other three aims is more manageable and achievable.

Who Offers Value-Based Contracts?

Value-based contacts are offered both by the Centers for Medicare and Medicaid Services (CMS) and commercial insurance payers. Most major commercial health insurance companies now offer some kind of value-based incentive payment to providers.

fee for service

The Benefits of Value-Based Contracts

Value-based healthcare contracts and programs are not just growing in scope and popularity, but the rewards and incentives for participating in value-based contracts are also expanding. According to a recent study by Change Healthcare, payers are seeing an average of 5.6% in cost reduction, with some savings as high as 7.5%.

The same study also found that 77% of providers incorporating value-based contracts in their practice reported improvement in care quality. In addition, they also found improvements in provider relationships and patient engagement.

Reducing healthcare costs and increasing care quality are two of the main goals of value-based contracts. These study findings prove that shifting away from fee-for-service payment models towards value-based contracts has positive, measurable effects.

How Do Value-Based Contracts Work?

Each contract is different, but most of them work in a similar way. Contracts offer specific measures providers must demonstrate performance in. When providers prove that they’ve made improvements on contract measures, they become eligible to receive care payment reimbursements for their performance. This is usually done by aggregating EHR data.

Performance measures typically focus on preventative treatments and screenings, patient education and engagement, smoking cessation, and blood pressure management. These measures are designed to identify potential health issues early, such as colorectal cancer screenings, and keep patients out of emergency rooms.

Catching potential health issues early or managing existing health concerns positively impacts patients and patient populations. Engaging patients and their caretakers so that they fully understand treatments, options, and potential complications gives everyone an active role in care. Education may also be the difference between a patient visiting their provider and taking a costly trip to the emergency room. These are the types of measures providers receive rewards for with value-based contracts.

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