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How Benefits Based on Performance will Reshape Healthcare Payment

If you are a health plan, hospital, or employer and have not started to think about the role of value-based care in your future payment models, you’re missing out on one of the biggest changes in health care.
August 14, 2022
How Benefits Based on Performance will Reshape Healthcare Payment

i 3 Table Of Content

​Value-Based Care: How Benefits Based on Performance will Reshape Healthcare Payment

What are the different types of value-based care?

Fee-for-Service

Fee-for-service is a type of value-based care in which providers are reimbursed for the services they render. This type of care has been prevalent in the United States for many years but is slowly being replaced by other models of value-based care. Under fee-for-service, providers are typically paid per procedure or visit. This type of reimbursement can create a financial incentive for providers to perform more procedures or see more patients, rather than focus on providing high-quality, cost-effective care.

Other types of value-based care include capitation, in which providers are paid a set amount per patient per year; risk sharing, in which providers share in the financial risk of providing care; and bundled payments, in which providers are paid a lump sum for all the services rendered during a particular episode of care. These other models of value-based care are becoming more common as payers look for ways to improve quality and contain costs.

Pay-for-Performance

Pay-for-performance is a type of value-based care that ties provider payments to quality or financial measures. Pay-for-performance programs aim to improve the quality of care while controlling costs.

Under a pay-for-performance program, providers may be rewarded for meeting or exceeding certain quality measures, such as reducing the number of hospital readmissions or improving patient satisfaction scores. Providers may also be penalized for failing to meet these benchmarks.

Pay-for-performance programs are often used in government health care programs, such as Medicare and Medicaid, as well as in private insurance plans. Some large employers also use pay-for-performance programs to control health care costs.

Shared Savings

Shared savings is a type of value-based care where providers work together to improve patient outcomes while lowering the overall cost of care. In a shared savings program, providers receive a portion of the savings generated if they meet certain quality targets. This type of arrangement gives providers an incentive to improve patient outcomes while also controlling costs.

One advantage of shared savings is that it can help to align provider incentives with those of the payer. By sharing in the savings generated, providers have an incentive to provide high-quality care that leads to improved outcomes. This can help to improve the overall quality of care while also reducing costs.

Shared savings programs can also help to encourage provider collaboration and coordination. By working together toward common goals, providers can develop more efficient and effective ways of delivering care. This can lead to improved patient outcomes and lower costs over time.

How is value-based care different from traditional fee-for-service healthcare?

Value-based care is a type of healthcare payment model that reimburses providers based on the quality of care they deliver, rather than the number of services they provide. In other words, providers are paid for keeping their patients healthy, rather than for every test, procedure, or office visit.

Value-based care has the potential to improve patient outcomes and lower healthcare costs by incentivizing providers to deliver high-quality, efficient care. In contrast, fee-for-service healthcare reimbursement typically does not reward providers for improving patient outcomes or containing costs. As a result, value-based care has been gaining popularity in recent years as a way to improve the quality of care while controlling costs.

There are several different types of value-based arrangements, but all share the common goal of tying provider payments to quality metrics. Some common types of value-based arrangements include accountable care organizations (ACOs), bundled payment arrangements, and risk-sharing agreements.

How do value-based programs work with other CMS quality efforts?

In general, value-based programs aim to improve quality and efficiency by paying provider organizations based on how well they perform on specific quality measures. For example, a provider might be eligible for a bonus payment if it meets certain targets for reducing readmissions or improving patient satisfaction scores.

Other CMS quality efforts are also designed to improve care and save money. These include the Hospital Value-Based Purchasing program, which rewards hospitals with higher payments if they meet targets for quality of care; the Hospital Readmissions Reduction Program, which penalizes hospitals with excessive readmission rates; and the Medicare Shared Savings Program, which gives providers financial incentives to coordinate care and keep costs down for Medicare patients.

Value-based programs are often seen as complementary to these other CMS quality initiatives. For example, while the Readmissions Reduction Program penalizes hospitals for poor performance on readmission rates, a value-based program could reward providers who can reduce readmissions even further. Similarly, while the Shared Savings Program gives providers an incentive to lower costs, a value-based program could give providers an additional incentive to improve the quality of care they deliver.

What are the benefits of value-based care technologies?

Value-based care is a type of healthcare delivery model in which providers are reimbursed based on the quality of care they provide, rather than the quantity of care. This type of reimbursement model incentivizes providers to focus on delivering high-quality, efficient care that leads to better patient outcomes.

In addition to improving patient outcomes, value-based care has been shown to reduce healthcare costs. One study found that value-based care models reduced Medicare spending by $2.1 billion over three years. The same study found that the use of value-based care technologies led to a reduction in hospital readmissions and emergency department visits.

Value-based care is also associated with improved communication between patients and providers. In one study, patients who received care from a value-based primary care practice were more likely to report improved communication with their provider and increased satisfaction with their overall healthcare experience.

Overall, the evidence suggests that value-based care is an effective way to improve patient outcomes and reduce healthcare costs.

What are the key components of value-based care?

Clinical Quality

Value-based care is a type of healthcare delivery model that focuses on providing patients with high-quality care while also reducing costs. The key components of value-based care include clinical quality, patient satisfaction, and population health management.

Clinical quality is measured by looking at things like mortality rates, readmission rates, and complication rates. To improve clinical quality, providers need to focus on things like evidence-based medicine, coordination of care, and communication among providers.

Patient satisfaction is another important component of value-based care. This can be measured by looking at things like patient surveys and customer service metrics. To improve patient satisfaction, providers need to focus on providing clear communication, offering convenient appointments, and reducing wait times.

Population health management is the third key component of value-based care. This involves managing the health of a population of patients rather than just treating individual patients. To do this effectively, providers need to focus on things like disease prevention and health promotion.

Population Health

Value-based care is a healthcare delivery model that focuses on providing patients with quality care while also controlling costs. The key components of value-based care include:

  • Population health: This refers to the overall health of a population, rather than just individual patients. To improve population health, providers need to identify and address the underlying social, economic, and environmental factors that impact health.
  • Prevention: Value-based care focuses on preventing illness and promoting wellness, rather than simply treating disease. This can be accomplished through measures such as patient education, screenings, and immunizations.
  • Coordinated care: Value-based care requires coordination between all members of a patient’s healthcare team – including primary care physicians, specialists, pharmacists, and others. This ensures that everyone is working together to provide the best possible care for the patient.
  • Evidence-based medicine: This refers to using the best available evidence to make decisions about diagnosis, treatment, and prevention. In value-based care, this means using data and research to guide decision-making to improve outcomes for patients.

Cost

Value-based care is a healthcare delivery model aiming to provide quality care at a lower cost. The key components of value-based care include:

  • Coordinated care: Providers work together to coordinate the care of each patient. This helps to ensure that patients receive the right care, at the right time, and in the most appropriate setting.
  • Evidence-based medicine: Providers use the latest evidence and research to guide their decision-making. This helps to ensure that patients receive the most effective treatments available.
  • Patient engagement: Patients are actively involved in their care, including making decisions about their treatment options. This helps ensure that patients receive care tailored to their individual needs and preferences.

Who will value-based care impact?

Patient-Level Value

Patients will be the ultimate beneficiaries of value-based care. In a value-based care delivery system, providers are reimbursed based on the quality of care they provide, rather than the number of services they render. This encourages providers to focus on preventive care and disease management, which can result in better health outcomes for patients. In addition, value-based care models often give patients more control over their own health care decisions, which can lead to improved engagement and satisfaction.

Hospitals

Value-based care will impact hospitals by changing the way they are reimbursed for services. Instead of being paid for each service provided, they will be paid based on the quality of care they provide. This means that hospitals will need to focus on providing high-quality care to receive higher reimbursements. Hospitals will also need to track data to show how their care is improving patient outcomes.

Healthcare Care Organizations

The healthcare industry is moving towards value-based care, which means that providers will be reimbursed based on the quality of care they provide, rather than the quantity. This shift will impact everyone involved in the healthcare system, from providers to payers to patients.

Providers will need to focus on delivering high-quality care to receive reimbursement, which may mean changing the way they do business. For example, they may need to invest in new technology or hire more staff. Payers will also need to adjust their reimbursement models to align with value-based care. And finally, patients will benefit from receiving better quality care.

How Will Value-Based Payment Models Affect Me?

Value-based care is a healthcare payment model that ties provider reimbursement to the quality of care delivered. This type of care is also sometimes referred to as performance-based care or value-based reimbursement.

Under a value-based care model, providers are typically reimbursed for the health outcomes they achieve, rather than the number of services they provide. This shift from volume to value incentivizes providers to deliver high-quality, cost-effective care.

Value-based care models have the potential to improve patient outcomes and reduce healthcare costs. A recent study found that value-based payments were associated with a 12% reduction in hospital readmissions and a 5% reduction in emergency department visits.

While this type of healthcare payment model is still in its early stages, it’s expected to become more prevalent in the coming years. As such, patients need to understand how value-based payments could affect their access to quality care.

What are the goals of value-based care organizations?

To Improve Patient Outcomes

Value-based care is a healthcare delivery model in which providers are paid based on patient outcomes. The goals of value-based care are to:

  • Improve patient outcomes
  • Increase efficiency
  • Reduce costs

To achieve these goals, value-based care models typically focus on four key areas:

  1. Coordinated care: Providers work together to ensure that patients receive the best possible care.
  2. Evidence-based medicine: Providers use the latest evidence and research to guide decision-making.
  3. Patient engagement: Patients are actively involved in their care.
  4. Population health management: Providers focus on prevention and wellness for populations of patients, rather than individual patients.

To Improve the Patient Experience

The goals of value-based care are to improve the patient experience, improve population health, and lower healthcare costs. To achieve these goals, value-based care focuses on providing high-quality care that is evidence-based, coordinated, and patient-centered. Additionally, value-based care uses data and technology to drive continuous improvement.

Some specific ways that value-based care can improve the patient experience include:

  • Providing timely access to care
  • Improving communication between patients and providers
  • Enhancing coordination of care
  • Focusing on preventive care

Value-based care has the potential to transform the healthcare system by making it more focused on quality and outcomes instead of quantity. By improving the patient experience and population health while also lowering healthcare costs, value-based care has the potential to provide better value for all stakeholders in the healthcare system.

To Promote Population Health

There are several goals of value-based care, but one of the primary goals is to promote population health. Value-based care is a type of healthcare delivery that focuses on providing quality care at a lower cost. To achieve this, value-based care providers work to improve patient outcomes and prevent avoidable complications. This type of care delivery often includes coordinating care among different providers, using data to drive decision-making, and investing in preventive measures. By focusing on these areas, value-based care providers hope to improve the overall health of the population while reducing healthcare costs.

What are the challenges of implementing value-based care?

The challenges of value-based care organizations

There are several challenges associated with implementing value-based care, including:

  • Ensuring that all members of the care team are on board with the move to value-based care. This means ensuring that everyone understands what value-based care is and why it is important.
  • Make sure that all patients receive the same high level of care, regardless of their insurance status or ability to pay.
  • Collecting data and using it to drive decision-making. This includes being able to track outcomes and costs over time so that you can see if the value-based care model is working as intended.
  • Addressing social determinants of health. This means considering factors like housing, food insecurity, and transportation when designing care plans.

Value-based care is a complex shift that requires buy-in from everyone on the care team and careful data tracking to ensure success. Addressing social determinants of health is also critical to providing comprehensive, patient-centered care.

The challenges of sustaining value-based care

Several challenges need to be overcome to make value-based care sustainable. First, there is the challenge of provider buy-in. For value-based care to be successful, providers need to be on board with the changes that need to be made. This can be a difficult task, as many providers are resistant to change. Second, there is the challenge of data collection and analysis. To properly assess the success of value-based care, accurate data needs to be collected and analyzed. This can be a time-consuming and expensive process. Third, there is the challenge of reimbursement rates. Value-based care often requires a higher level of investment upfront, which can make it difficult to obtain reimbursement from payers. Fourth, there is the challenge of meeting patient expectations. Value-based care often requires a higher level of coordination and communication between providers, which can be challenging to achieve. Finally, there is the challenge of integrating value-based care into existing systems. Value-based care often requires changes to existing systems and processes, which can be difficult to implement successfully.

Less Focus on Value-Based Care Could Alter System Performance

There are a few challenges that could come up when implementing value-based care. One challenge is that there could be less focus on value-based care, which could alter system performance. Another challenge is that some providers may be resistant to change. And lastly, payers may not want to invest in the infrastructure needed to support value-based care.

Despite these challenges, value-based care has the potential to improve patient outcomes and reduce costs. When implemented correctly, value-based care can help provider organizations achieve their Triple Aim goals of improving population health, reducing costs, and improving patient experience.

How can value-based care be successful?

The healthcare industry is shifting from a fee-for-service model to a value-based care model. In this new model, providers are paid based on the quality of care they provide, rather than the number of services they render. This shift is being driven by several factors, including the Affordable Care Act, which ties provider reimbursement to quality measures; the rise of consumerism in healthcare; and the increasing focus on population health management.

There are several ways to measure quality in healthcare, but some common metrics include patient satisfaction scores, readmission rates, and mortality rates. Providers who deliver high-quality care will be rewarded with higher payments from insurers, while those who fail to meet quality standards will see their payments reduced.

The transition to value-based care will not be easy for all providers. Those who have been successful in the fee-for-service model may need to make significant changes to their practices to succeed under a value-based system. Additionally, all providers will need to invest in data collection and analysis to track their progress against quality measures.

Despite these challenges, value-based care has the potential to improve the quality of care for all patients while also reducing costs. When done correctly, it can be a win-win for providers and patients alike.

How will value-based care innovation reshape healthcare payment?

Value-based care is a type of healthcare payment model that reimburses providers based on the quality of care they deliver, rather than the number of services rendered. This type of reimbursement incentivizes providers to focus on delivering high-quality, efficient care that results in positive health outcomes for patients.

There are several ways in which value-based care can be delivered, such as through pay-for-performance contracts, bundled payments, and capitation arrangements. In each case, provider reimbursement is linked to meeting certain quality metrics, such as reducing hospital readmissions or lowering the rate of avoidable complications.

The shift to value-based care represents a major shift in how healthcare is paid for and delivered in the United States. For providers, it means moving away from a fee-for-service model that rewards volume over quality. For patients, it means better access to high-quality care that is tailored to their individual needs.

Overall, the move to value-based care will help to improve the quality of healthcare while also controlling costs. This type of innovation is essential to make our healthcare system more sustainable in the long run.

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Value-Based Care
Accountable Care Organization
Accountable Care Model
Alternative Payment Models
AndrewRittler - Chief Executive Officer

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Andrew Rittler

Andrew Rittler, Chief Executive Officer, joined MITEM Corporation in 2013 to bring the eVigils platform to market and lead product direction. Andrew has a 35-year history in healthcare technology leading consulting, sales, and service operations.

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