Value-based care is a new approach to health care reimbursement that rewards providers for positive patient outcomes rather than the number of tests and procedures performed. It also encourages patients to take a more proactive role in their healthcare by focusing on wellness and prevention.
Nonclinical factors like individual preference, social determinants of health (SDoH), sexual orientation and gender identity, and cultural or religious perspectives should be incorporated into value-based programs.
Prioritize Prevention
With value-based care, physicians get paid for patient outcomes rather than the time spent on a particular service. That makes it more attractive for doctors to focus on wellness and prevention, saving the health system money.
Providing patients with the tools they need to lead healthy lives is also key. One such tool is a shared electronic medical record (EMR), which allows patients to stay on top of their health status, receive alerts when scheduling appointments, and connect with specialists.
However, if the EMR is properly implemented, it can be easier for patients to navigate the system. If it’s not easy for patients to stay on top of their health status, they are less likely to follow their physicians’ orders.
Physicians can help bridge the gap by making their recommendations more concise. They can also encourage patients to eat healthier and exercise regularly, reducing the risk of chronic diseases.
Focus on the Whole Patient
In value-based care, healthcare providers are incentivized to focus on health outcomes, not just the quantity of services provided. This can be achieved by reducing medical errors, increasing provider communication, and focusing on overall patient health. In this way, the model reduces waste and inefficiencies across all aspects of the healthcare process.
By embracing software for value based care, payers can align reimbursement models with the comprehensive, preventive approaches that many physicians already practice. This allows them to cultivate strong patient relationships and create the workflows necessary to coordinate care. In addition, value-based care can help payers control costs by lowering risk and spreading it amongst a larger population of patients.
In this way, value-based care can help ensure patients receive the appropriate, high-quality care without unnecessary tests or procedures. As a result, society becomes healthier while decreasing overall healthcare spending. This includes reducing costly hospitalizations and medical emergencies while lowering the cost of managing chronic diseases. These changes will require significant transformation from the current fee-for-service paradigm.
Prioritize Patient-Centered Care
Value-based care models incentivize providers to improve quality measures, typically preventing or managing chronic diseases (such as diabetes) and improving patient outcomes. They also emphasize timeliness (ensuring treatment is available without long delays) and cost (minimizing the need for expensive interventions like emergency department visits and inpatient admissions).
A key challenge to implementing value-based care is ensuring that healthcare teams are well-integrated. This means having systems that share information and provide data insights that enable physicians to prioritize care. This often requires deploying advanced technology to manage disparate clinical, EHR, and provider network data storage procedures.
One way to achieve this goal is by enabling physician groups and integrated care teams to work together across their organizations. Whether through ACOs, PCMHs, or other initiatives, these teams allow physicians to coordinate their patients’ needs better and ensure that the appropriate providers deliver high-quality, individualized care. This type of collaboration also benefits patients, as it helps to alleviate feelings of being overwhelmed and overburdened by their health concerns and increases overall satisfaction.
Focus on Patient Engagement
Getting patients to participate in their healthcare actively is an essential goal for providers moving into the value-based care landscape. Patient engagement inspires adherence to treatment plans, medication regimens, and other health-related activities that improve outcomes and lower costs.
One of the best ways to promote patient engagement is by ensuring that each patient receives personalized communication that shows they are being heard and understood. This can be achieved by using technology to address the specific needs of each individual, for example, by delivering appointment reminders that are addressed to the patient by name or sending them a follow-up note after their visit to check on their condition.
Another way to encourage patient engagement is by providing financial incentives aligned with their quality and outcome measures. Payers can do this by utilizing bundled payments that cover an entire episode of care or by creating a network of provider organizations responsible for managing a specific attributed population. This allows them to control their cost growth better and reduce risk, which helps them keep their premium pools and investment levels stable.
Focus on Population Health
In value-based care, physicians and healthcare organizations can examine patient populations through a new lens. Focusing on the whole patient can help them recover more quickly and prevent chronic diseases from arising in the first place, resulting in fewer doctor’s visits, medical tests and procedures, and lower costs.
To do this, they need to have complete visibility into the characteristics of their patients, including clinical risk levels and nonclinical factors like financial stress, housing instability, and the availability of healthy food. This requires shifting from contracting and physician compensation to digital medicine and care management.
A key strategy for accelerating this transformation is implementing new payment models that align reimbursement with outcomes. These can include upside-only risk, in which providers gain revenue if they exceed certain quality, cost, or equity goals, or downside-risk models that penalize providers who fail to meet performance expectations. The timing, size, and delivery of these incentives are crucial, as evidence suggests that they are more effective when offered directly to providers and delivered without delay.
