Value-Based Care, Reducing The Price of Recovery
PUBLISHED JAN. 17, 2023
Value-based care is an alternative to the traditional fee-for-service reimbursement model that many healthcare providers use. Value-based care is specifically used to benefit Medicare users and improve the quality of services provided to them. Instead of reimbursing healthcare providers based on the number of patients who were provided services, they are compensated based on the quality of the services offered. This model aims to improve the care provided to individuals as well as decrease the cost of healthcare and improve population health management strategies. Overall, value-based care models focus on the outcomes of patients and how healthcare providers can improve the quality of care they provide.
There are three main value-based care models. Accountable Care Organizations (ACOs), Bundled Payments, and Patient-Centered Medical Homes (PCMH). ACOs are networks of healthcare providers that provide Medicare beneficiaries high quality, coordinated care. ACOs aim to prevent unnecessary services and reduce medical errors in treatment. Healthcare providers volunteer to enter the ACO network. Under this system, this network of healthcare providers shares savings if the network is able to deliver high-quality care and reduce the costs of its services. When a provider joins an ACO network they are putting themselves at potential financial risk as while there is potential for shared savings there is potential for shared losses if the ACOs can’t provide high-quality care.
Bundled Payments are another form of the value-based care model. With a bundled payment model, providers are reimbursed collectively based on the expected cost of a specific treatment. What this means is that if a patient undergoes surgery, instead of paying the hospital, surgeon, and anesthesiologist individually they would be reimbursed with one big payment. Providers stand to benefit from this as if they can reduce the cost of the care below the expected price they can pocket the savings. On the other hand, if they cannot then they stand to lose money.
The final value-based care model is PCMH. The PCMH is designed to provide its patients with a centralized care setting that meets the different needs of patients. The PCMHs provide patients with patient-centered care, team-based methods, population health management, personal care management, care coordination, and consistent quality care. This model separates itself from the other two by being a new form of treatment center that upholds the values of value-based care, rather than implementing a new system of value-based care reimbursement into an existing medical system or facility.
The main goal of these systems is to increase the availability of treatment by reducing the cost of treatment and increasing its quality of it. 21 million Americans suffer from addiction but only 10% of people actually receive treatment. This is because many treatment centers cannot afford to supply comprehensive addiction treatment as through the fees-for-service system they are unable to be properly reimbursed for the treatment they supply. In a fee-for-service system healthcare providers like treatment centers or rehabilitation centers that treat a lower quantity of patients, but provide those patients with higher quality and more intensive care and services are not being reimbursed for the true value of their care. In a value-based care system, these facilities can be properly reimbursed for the quality and intensiveness of their care and in turn, continue to grow and improve their services.