Value-Based Care: Delivering More Using Less

Amy Sebesta

What is Value-Based Care?

Value-based care is a healthcare delivery model which reimburses providers based on the quality of care and patient outcome rather than a fee-for-service approach. Fee-for-service models differ from value-based care in that providers are paid based on the quantity of services delivered. Value-based care changes the way physicians and providers care for patients. A more holistic and cost-effective approach is adopted where overall wellness is evaluated to improve patient health in the long run.

Benefits of Value-Based Care

There are many reasons why value-based care is thought to be a great approach to healthcare delivery. Below are just a few of the major benefits of adapting a value-based care payment model:

  • Lower Cost for Patients
  • Quality Patient Care
  • Holistic Approach to Patient Health
  • More Efficient Care
  • Stronger Cost Controls
  • Reduced Risk for Payers
  • Reduced Health Costs/Spendings
  • Healthier Society

Healthcare Industry Challenges

The idea of delivering more using less seems like the same turnip we have all tried to squeeze countless times before. With the emerging addition of Value-Based Care (VBC) reimbursement models, now the struggle to keep pace in a mixed-mode, straddling everything from Fee-for-Service to Full Risk Sharing contracts, is real. While payers are becoming more transparent in sharing risk-based patient population data with providers, the lack of VBC contract performance standards across plans and mountains of cost, utilization, gap, and stars data can make the idea of efficiently managing such arrangements seem about as possible as winning the next mega lottery jackpot.

In recent travels, I have seen first-hand how arduous the process can be. The adventure begins with the fact that payer provided data is stale, refreshing in PDF format – Excel if you are lucky – once a month. From here, data must be further scrubbed to determine if gaps identified by the payer are actually real: is the claim still in progress, was a code missed when billing, or perhaps results came in since the report refreshed. Gaps in error are then closed in the corresponding payer’s online portal or worse, a dreaded paper dispute form. And now, days to weeks later, the data is ready to be acted on at the patient level by the site’s care team.

The Future of Value-Based Care

The bottom line is the healthcare system, as it is today, is not sustainable. But the good news is that opportunity to transform exists using better, cleaner data to drive decisions, track performance, and enable faster point of care action. We must now, more than ever, fully understand our patients – and we can’t do it alone. Instead of doing more with less and continuously squeezing that turnip, utilize the data you work so hard to capture and incorporate it into the right technology to clearly show where improvements can be made.

The steady shift towards Value-Based Care sparked by CMS makes sense for us, as an industry, in the spirit of affordable and quality care for patients. We have more data than ever at our fingertips from point-of-care EHRs to interfaces with care partners and beyond to help inform care. Now is the time for us to bring tangible improvement back to the care teams to efficiently engage and nurture their patients. Virence Health is committed to delivering such technology and solutions to prioritize the right interventions, manage populations, deliver consistent care and better manage to value-based payment models.