The U.S. healthcare industry is moving toward a value-based care (VBC) reimbursement model as encouraged by initiatives from the Centers for Medicare and Medicaid Services (CMS). In a value-based model, providers are paid depending on patient outcome rather than on volume of procedures performed. Theoretically, this promotes a focus on patient wellness and preventative medicine, which would improve overall health and reduce both the incidence and severity of chronic illness in the general population.
In addition to improving population health, VBC is intended to reduce healthcare costs for patients and providers. Though healthcare providers and patients are the primary beneficiaries in a value-based system, payers and suppliers may also profit.
1. Providers: improve patient satisfaction and increase operational efficiency
When physicians and other care providers address a patient’s overall health rather than an acute episode of care, the patient is likely to report greater satisfaction. Focusing solely on symptom management is ineffective if a physician doesn’t also take into account other factors impacting patient health, such as environment, diet, and pre-existing conditions. A holistic approach may also increase trust in physicians, which positively impacts patient engagement and has been shown to improve care outcomes.
Lowering costs associated with chronic illness management frees up funds that can be used to institute more efficient workflows—including technologies like telehealth and check-in kiosks that reduce wait times and can improve care outcomes. Providers can also spend more time focusing on preventative medicine and population health issues rather than struggling to keep up with high patient demand and readmissions.
2. Suppliers: demonstrate how products improve outcomes at lower costs
Any sales rep knows that the key to closing a deal is to demonstrate value. Suppliers who are familiar with the healthcare market understand the role of value-based care in purchasing decisions and can use this knowledge to target hospitals and health systems based on diagnoses, procedures, and value-based care performance.
For example, if a medical device supplier offers antibiotic-infused surgical sutures that can reduce the risk of patients developing surgical site infections, that would improve care outcomes and the facility would be reimbursed at a higher rate under VBC. The higher supply costs that may be associated with specialty sutures pale in comparison to the costs and patient health risks associated with treating healthcare-associated infections—making it an easy sell for suppliers.
3. Payers: value-based care reduces risk and lowers spending
Healthcare payers assess risk by balancing smaller populations of unwell patients with a larger population of generally healthy patients. The healthier the general population is, the fewer claims will be filed—saving payers money and reducing the risk of significant financial loss. In the long run, healthier patient populations can reduce individual premiums and copays.
In 2019, only 56 percent of hospitals participating in Value-Based Purchasing received a positive adjustment. Many providers are not fully prepared to effectively benchmark hospital performance, understand payer mix, and lack comprehension of their competitors in the wider market.
Catch an on-demand replay of our webinar, Value-Based Care in 2019 and Beyond, to hear first-hand experiences from healthcare thought leaders at Mayo Clinic, Dell Medical School & UT Health Austin, and more!
This panel will cover topics ranging from:
The current state, growth trajectory, and impact of Value-Based Care
Provider benefits such as increased collaborations and incentive opportunities
Provider challenges such as tracking and predicting those types of surgeries in their market, staffing properly, and facing a social worker shortage
Predictions of the future of Value-Based Care and how to capitalize on rising opportunities such as implementing health IT systems to handle population health initiatives
ABOUT THE AUTHOR
Alanna Moriarty is a healthcare industry writer and content strategist. As the Content Marketing Manager for Definitive Healthcare, she most enjoys connecting the dots between data and care delivery. ...