what is value-based care

What is Value-Based Care and How to Make the Transition

The value-based care transformation is here. Are you ready?

What is Value-Based Care?

Value-based care is a paradigm shift in healthcare that focuses on increasing the quality of care and reducing the cost, thus having a greater impact on population health. Instead of the fee-for-service model that addresses patient care as health issues arise, value-based care contracts reward providers for maintaining the health of their patient populations. This is also known as “volume to value.”

Value-based care contracts are opportunities for providers to harness their clinical data to hit contract-specific benchmarks. By reaching these benchmarks, providers are compensated for taking action to ensure the long term health of their patients.


value-based care

Why Transition to Value-Based Care?

Primary care providers are typically burdened with expensive patients who are the product of systemic issues within the current healthcare system. Value-based care delivery helps save money, increase patient engagement, leads to better health outcomes, and rewards providers for taking the steps necessary to prevent emergency room visits and hospital readmissions.

Patient lives are attributed to their primary care providers by their payer; the providers, in turn, bear the brunt of the heavy lifting when patients encounter a medical issue. Primary care providers should be reaping the rewards from value-based care contracts for proactively managing the health of their patient populations with preventative measures and screenings. The transformation from fee for service to value-based care is being built on these providers hard work.

How to Transition to Value-Based Care

One of the most difficult questions to answer is how to transition to a value-based care model. The federal government has kicked off this transition by shifting to the Quality Payment Program, which offers two tracks—MIPS and APMS—and includes requirements for meeting clinical quality measures. Such payment models like MIPS (merit-based incentive payment system), CPC+ (Comprehensive Primary Care Plus), ESRD (end-stage renal disease), and MSSP (Medicare Shared Savings Program) and any of its tracks are part of the QPP under MACRA. Commercial payers have also begun to offer value-based contracts of the QPP ilk.

Knowing the value-based health care landscape and contracts is the first step to transitioning away from fee-for-service. Value-based care contracts reward providers for hitting certain benchmarks set by the federal government or commercial insurance companies.

Understanding your data and using it to drive care is key to transitioning to value-based health care. Collecting and aggregating data allows you to see how you’re performing against national benchmarks. But how can providers keep track of data— some from disparate EHR systems—to ensure they’re hitting all their benchmarks to maximize reimbursements and avoid penalties?

One way is to join the Physician Choice Network (PCN), hosted by Healthcare Innovation Solutions, Inc. (HCIS), a New Jersey Innovation Institute company. Membership in PCN offers providers access to state-renowned coaching, support, and technological tools to ensure you hit your measures benchmarks and close care gaps.

One tool in the PCN arsenal is Measures Manager™. Measures Manager™ aggregates data from disparate sources into a streamlined, easy-to-read dashboard. This dashboard allows providers to see how they’re performing on gap closure for each of the contracts they’re enrolled in. By having this information readily available, providers are able to look at the big picture and also drill down into the data, digging into which providers run the biggest risk for not closing measures gaps and which patients need the most attention.

Start your value-based care transition with a full team of coaching and support behind you! Contact us today for more information about how you can join the Physician Choice Network and get started with Measures Manager™.

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