What Is Value-Based Healthcare?

What Is Value-Based Healthcare? | CareerStaff Unlimited

Value-based care has come to dominate the healthcare industry over the past decade. But what is value-based healthcare, exactly? And why is it important for healthcare providers and administrators to embrace this new model of patient care?

What Is Value-Based Healthcare?

Value-based healthcare refers to a system of paying for care that’s based on overall outcomes, rather than on individual services. This system, technically called value-based care, is meant to replace the older fee-for-service model that’s served as the default approach in the United States for decades.

Historically, this fee-for-service model reimbursed healthcare providers for each service provided within the care continuum, after it was provided. In this sense, an annual check-up could be completely unrelated to reimbursement for testing, imaging or the treatment of that same patient’s chronic conditions.

Value-based care, on the other hand, considers reimbursement as part of a continuum. Providers are compensated based on specific outcomes like reduced hospital admissions and re-hospitalizations. Specific models that embrace this philosophy, like the Chronic Care Management (CCM) model, reward practitioners for continuous communication and interaction that’s based around building and following a specific treatment and medication regimen for each patient.

Because the traditional fee-for-service model was believed to cause unnecessary utilization by failing to approach care holistically, the Centers for Medicare & Medicaid Services (CMS) has been actively pushing the move to value-based healthcare. In making this transition, CMS hopes to succeed in implementing the “triple aim” across the healthcare industry — that of “providing better care for individuals, improving population health management strategies, and reducing healthcare costs,” as Jacqueline LaPointe writes at RevCycleIntelligence.

And because CMS represents the largest insurer in the U.S., many private payers have had little choice but to follow suit. As a result, many healthcare organizations have found it necessary to embrace value-based care. It’s no small job, either. New strategies and operational reorganization are often required. As such, some facilities that provide patient care services have yet to make the transition, or have done so in an ad hoc manner, keeping up with new requirements rather than anticipating reimbursement trends.

How to Implement Value-Based Healthcare

So, where to begin in the transition to value-based healthcare care? What type of reimbursement metrics and models apply to the facilities in your organization? Current value-based healthcare programs include:

  • End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
  • Hospital Value-Based Purchasing (VBP) Program
  • Hospital Readmission Reduction Program (HRRP)
  • Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
  • Hospital Acquired Conditions (HAC) Reduction Program
  • Skilled Nursing Facility Value-Based Purchasing (SNFVBP)
  • Home Health Value Based Purchasing (HHVBP)

The applicable model will depend on the type of facility; for instance, rehab centers and VA facilities are exempt from the Hospital Value-Based Purchasing Program, while the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program applies only to SNFs. Facilities that fail to meet specific targets will receive reduced reimbursement based on the rules of each applicable category.

There are a number of ways that providers can use to meet these new standards, including:

  • Accountable care organizations (ACOs), a group of healthcare providers who pool their resources to implement the improvements needed to receive full reimbursement
  • Bundled payments, including the Bundled Payments for Care Improvement Advanced (BPCI Advanced), a model that works to bring together a “patient’s entire health care team – including the providers from all health care settings,” and enabling them to “communicate and collaborate on quality and total cost of a patient’s care.”

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Even though the concept is familiar to some by now, value-based healthcare is still out of focus for many providers.

“Value-based care is still a new concept for most healthcare providers, and many are still trying to implement the appropriate systems into their workflow,” LaPointe points out, going on to cite a survey stating that “transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces.”

The good news is that organization seeking help aligning with the new standards of value-based healthcare have a number of resources available to them. For instance, partnering with a healthcare managed services provider (MSP) can help entire organizations more readily make the transition, while offering additional benefits like better access to high-quality clinical workers and the means to boost efficiency on a tight budget.

> Take a deeper dive into how MSP helps providers transition to value-based care

If you’re interested in learning more about how healthcare managed services providers can help your organization achieve value-based healthcare, we’re standing by to answer your questions. Contact us here to schedule a complimentary consultation with a CareerStaff expert today.

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